Risk Adjustment Compliance Auditor

🕒 May 23

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Conduct provider and coder-level audits • Review medical record documentation and coding accuracy • Identify compliance risks and outliers • Support RADV and other risk adjustment audit initiatives • Partner closely with Risk Adjustment leadership and cross-functional teams • Help ensure coding accuracy, regulatory compliance, audit readiness, and corrective action follow-through across the organization • Provide audit feedback and compliance education to internal and provider-facing stakeholders as needed

🎯 Requirements

• Minimum 3 years of professional coding experience in a medical group or health plan setting • Bachelor’s degree in business administration, health care management or in a related field or 4 years additional experience in lieu of education • Certified Coder required - CPC, CCS & CCS-P • Experience with strategic planning in risk mitigation. • Previous use of Epic, Allscripts, EZCap a plus. • Proficient user in MS office suite, MS access a plus. • Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.

🏖️ Benefits

• Flexible working hours available post-training based on business needs and team collaboration • Health insurance • Professional development