Sr. Risk Adjustment Auditor

Responsibilities

• Audit third-party vendor coding and CDI outputs to ensure accuracy and compliance
• Audit internal CDI Specialist work, including chart reviews and reconciliation
• Identify coding inaccuracies, unsupported diagnoses, and missed HCC opportunities
• Deliver audit findings, trend analysis, and corrective action recommendations
• Review completed encounters in the post-visit, pre-billing window to validate documentation
• Evaluate alignment between medical record documentation and draft claims
• Assess diagnoses for ICD-10-CM specificity and MEAT criteria compliance
• Translate audit findings into targeted provider and team education
• Partner with CDI, coding, and leadership teams to improve workflows and policies
• Design and facilitate education sessions on ICD-10-CM and risk adjustment compliance

Requirements

• Associate's or Bachelor's degree in Health Information Management, Nursing, or a related clinical field
• 5+ years of experience in risk adjustment, medical coding, CDI, or auditing
• 2+ years of experience in prospective and concurrent review risk adjustment coding and auditing
• Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding
• CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) certifications required
• Advanced knowledge of ICD-10-CM Official Guidelines and AHA Coding Clinic guidance
• Ability to travel up to 25% for provider education or team collaboration

Preferred Qualifications

• CCS, CCDS, RHIT, or RHIA certifications
• Experience auditing vendor-delivered work or CDI programs
• Familiarity with CDI workflows, EMR systems, and coding/audit tools

About the Company

At Honest Health, we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholders to deliver innovative solutions that elevate care, control costs, and support long-term health.