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Medicare Risk Adjustment Audit Jobs in Utah (NOW HIRING)

Imh

Actuarial Manager

Murray, UT · On-site

$78.66 - $121.47/hr

Assists the risk adjustment department with strategy and data analysis. * Oversees the state ... Medicare Bids * Medicaid Expertise * Reserving * Provider Contracting Expertise * Communication of ...

Imh

Value Based Care Director - Select Health

Murray, UT · On-site

$59.50 - $91.84/hr

Familiarity with risk adjustment, Star Ratings, quality bonus payments, and CMS policy as they relate to value-based strategy in Medicare Advantage. Location: SelectHealth - Murray Work City: Murray ...

KCH Career Page

Business Office Manager

Kanab, UT · On-site

... Medicare Secondary Payer, consent, notice, and financial information before or at the time of ... Monitor cash collections, payment posting accuracy, contractual adjustments, underpayments ...

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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 Utah?

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

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

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

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

Cities in Utah 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 Utah as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution.

Risk Adjustment Campaign Associate (Risk Adjustment Coordinator)

Salt Lake City, UT • Hybrid

Cambia Health Solutions
Health Care and Social Assistance • 1 - 5K employees

8.4

Company rating: 8.4 out of 10

Based on 32 frontline employees who took The Breakroom Quiz

123rd of 314 rated insurance

People enjoy working here

Good employer

Paid breaks

Learn more about Cambia Health Solutionsexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 13 days ago

Job description

Risk Adjustment Campaign Associate

Hybrid role(3days/weekin office)atourPortland, Medford, Burlington, Vancouver, Renton, Boise, Lewiston, Spokane or Salt Lake Cityoffices. Candidates must reside within commutable distance of that location.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Risk Adjustment Campaign Associate is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Campaign Associate works with the Risk Adjustment operations team on on-going activities related to Medicare Advantage and Commercial risk adjustment campaigns. Working under the direction of the Manager of Campaign Execution and alongside other cross functional teams, the campaign associate is responsible for day to day operations and performance of risk adjustment campaigns. The Risk Adjustment Campaign Associate is also responsible for internal EMR medical record retrieval for all Risk Adjustment campaigns - all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Risk Adjustment Campaign Associate would have a Bachelor's Degree in business, project management, healthcare, or related field and at least 2 years of experience in a project support role (preferably within health care), or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Certificate or training in Project Management a plus

CPC and CRC certification a plus

Skills and Attributes:

Ability to manage small, less complex projects with minimum supervision.

Experience with Microsoft Office suite of tools.

Demonstrated analytical and problem-solving skills.

Experience in project management methods and techniques.

Ability to interpret service provider contracts and statements of work (SOW).

Knowledge of Facets, PIMS, and claims processes is preferred.

Ability to track and monitor service provider performance and delivery quality against service level agreements (SLAs).

Ability to communicate effectively, verbally and in writing, with all levels of leadership.

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

Monitors daily vendor performance against project schedule.

Supports the preparation of project reports and presentation of information to management, project teams, and client/customer groups.

Monitors project documentation for compliance with standards.

Develops and maintains the overall project documentation library ensuring that all documentation is established, maintained and retained as necessary in project databases.

Applies continuous quality improvement techniques and methodologies to all facets of job responsibility.

May plan and manage small, well-defined projects or sub-projects under the general direction of more senior project managers.

May retrieve medical records for MA and ACA campaigns through internal EMR access based on production goals set by the manager of Risk Adjustment Campaigns.

Work Environment

Work is primarily performed in an office or remote work environment.

Travel may be required, either locally or out of state.

Oregon, Washington, Utah, and Idaho:The expected hiring range is$62,900.00 - $85,100.00, the full salary range is$59,000.00 - $97,000.00and the bonus target is5%.

About Cambia


Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.


Why Join the Cambia Team?


At Cambia, you can:

  • Work alongside diverse teams building cutting-edge solutions to transform health care.
  • Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
  • Grow your career with a company committed to helping you succeed.
  • Give back to your community by participating in Cambia-supported outreach programs.
  • Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.


In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:


  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

Learn more about our benefits.


We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.


As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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