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Medicare Risk Adjustment Audit Jobs in Georgia (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Centerwell

Risk Adjustment Coding Analyst

Atlanta, GA · On-site

Experience supporting healthcare operations, risk adjustment, coding operations, audit reporting ... CDI tracking, provider education reporting, or similar regulated activities. * Convert complex data ...

Urrly

Telehealth Nurse Practitioner

Atlanta, GA · On-site +1

$600 - $720/day

Familiar with HEDIS and risk adjustment workflows * Medicare and Medicaid provider enrollment required * Comfortable delivering care through telehealth platforms Nice to have * Value-based care model ...

Emory Healthcare

CDCE Data Analyst

Atlanta, GA · On-site

Risk adjustment trends * Patient Safety Indicators (PSI) and Hospital-Acquired Conditions (HAC) * Provider performance metrics Compliance & Audit Readiness * Monitor documentation practices for ...

Emory Healthcare

CDCE Data Analyst

Atlanta, GA

$52.37 - $65.06/hr

Risk adjustment trends * Patient Safety Indicators (PSI) and Hospital-Acquired Conditions (HAC) * Provider performance metrics Compliance & Audit Readiness * Monitor documentation practices for ...

Emory Healthcare

CDCE Data Analyst

Atlanta, GA

Risk adjustment trends * Patient Safety Indicators (PSI) and Hospital-Acquired Conditions (HAC) * Provider performance metrics Compliance & Audit Readiness * Monitor documentation practices for ...

CINQCARE

Practice Success Partner

Atlanta, GA · On-site

$120K - $145K/yr

... Risk Adjustment teams, who set strategy and targets; flag practice-level gaps to them and drive practice adoption of the resulting action items. Does not perform chart review, coding audits, or other ...

Deloitte

Medicaid Actuarial Manager

Atlanta, GA · On-site

Experience with risk adjustment mechanisms * Experience with Provider reimbursement streams (i.e ... Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for ...

Deloitte

Medicaid Actuarial Manager

Atlanta, GA · On-site

Experience with risk adjustment mechanisms * Experience with Provider reimbursement streams (i.e ... Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for ...

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Medicare Risk Adjustment Audit information

What is a Medicare Risk Adjustment Audit?

A Medicare Risk Adjustment Audit is a review process conducted to ensure that healthcare providers are accurately reporting patient diagnoses to Medicare Advantage plans. This audit verifies that submitted diagnoses are supported by proper medical documentation, which affects how much Medicare pays to health plans. The goal is to prevent overpayments or underpayments and to ensure compliance with federal regulations. These audits are typically performed by the Centers for Medicare & Medicaid Services (CMS) or their contractors.

What are some common challenges faced by professionals in Medicare Risk Adjustment Audit roles, and how can they be addressed?

Professionals in Medicare Risk Adjustment Audit roles often encounter challenges such as interpreting complex medical documentation, staying updated on evolving CMS guidelines, and ensuring data accuracy for compliant risk scoring. Effective collaboration with coders, providers, and compliance teams is essential to resolve discrepancies and achieve audit objectives. Staying proactive in ongoing training and leveraging audit technologies can help address these challenges and contribute to high-quality, compliant results.

What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Auditor, and why are they important?

To thrive as a Medicare Risk Adjustment Auditor, you need expertise in medical coding, healthcare compliance, and an understanding of CMS risk adjustment guidelines, often supported by a coding certification such as CPC or CRC. Familiarity with auditing software, electronic health records (EHRs), and data analytics tools is typically required. Attention to detail, analytical thinking, and strong communication are essential soft skills for reviewing documentation and conveying findings. These skills are crucial for ensuring accurate risk adjustment coding, regulatory compliance, and optimized reimbursement for healthcare organizations.

What is the difference between Medicare Risk Adjustment Audit vs Medicare Coding Specialist?

AspectMedicare Risk Adjustment AuditMedicare Coding Specialist
Primary FocusReviewing and verifying accuracy of risk adjustment dataAssigning correct medical codes for billing and documentation
CertificationsRisk adjustment or auditing certifications often preferredMedical coding certifications like CPC or CCS
Work EnvironmentHealthcare organizations, insurance companies, auditing firmsHospitals, clinics, billing companies
Industry UsageUsed in Medicare Advantage plan compliance and reimbursementUsed in medical billing and claims processing

While both roles involve healthcare data, Medicare Risk Adjustment Auditors focus on verifying the accuracy of risk scores for Medicare payments, whereas Medicare Coding Specialists assign medical codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within the healthcare industry.

What are popular job titles related to Medicare Risk Adjustment Audit jobs in Georgia?

For Medicare Risk Adjustment Audit jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Medicare Risk Adjustment Audit jobs in Georgia look for?

The top searched job categories for Medicare Risk Adjustment Audit jobs in Georgia are:

What cities in Georgia are hiring for Medicare Risk Adjustment Audit jobs?

Cities in Georgia with the most Medicare Risk Adjustment Audit job openings:

Medicare Risk Adjustment Audit jobs near you
Infographic showing various Medicare Risk Adjustment Audit job openings in Georgia as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Auditor, Risk Adjustment

Oscar Health

Atlanta, GA • Remote

$82K - $108K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 28 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

261st of 312 rated insurance

Job description

Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:  Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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