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Medicare Risk Adjustment Audit Jobs in Virginia (NOW HIRING)

Risk Manager

Alexandria, VA ยท On-site

$119 - $130/hr

... necessary adjustments such as limit increases and policy extensions. * Oversee and maintain ... Conducts annual MVR audits and oversees tracking of personal auto certificates of insurance (COIs ...

New

Audit Manager - CPA Required

Mclean, VA ยท On-site

$77K - $125K/yr

This position requires great attention to detail, mastery of process documentation, risk assessment ... adjustment of the job application or interview process due to a disability, please call 703-236 ...

Health Data Engineer - Mid

Tysons, VA ยท On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

Health Data Engineer - Mid

Tysons, VA ยท On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

Health Data Engineer - Mid

Tysons, VA ยท On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

Showing results 41-60

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

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

Infographic showing various Medicare Risk Adjustment Audit job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution.

Risk Manager

Hirebridge

Alexandria, VA โ€ข On-site

$119 - $130/hr

Other

Posted 3 days ago

New


Key responsibilities

  • Identify, assess, and mitigate potential risks by following risk management strategies, policies, and procedures.

  • Review and analyze insurance requirements in bid documents, contracts, and agreements, and manage related insurance coverage and certificates.

  • Track and administer project-specific and company-wide insurance programs, including schedules of insurable assets, subcontractor requirements, and program compliance.


Job description

The Risk Manager will identify, assess, and mitigate potential risks that could impact the companyโ€™s health and objectives by following PCโ€™s risk management strategies, policies, and procedures to minimize threats and ensure compliance with regulations. Key functions include administration of the Corporate Property & Casualty Program, Contractor Controlled Insurance Program (CCIP), Subcontractor Default Insurance Program (SDI), Builderโ€™s Risk, and other project-specific coverages and providing timely and accurate review, analysis and recommendations of insurance coverage related to construction contracts, lease agreements, subcontract agreements, purchase orders and consultant agreements in collaboration with other corporate departments.

The right candidate will have 8-10 years of proven experience in construction risk management, insurance underwriting, or account management. Extensive knowledge of the insurance market and strong organizational, time management, and analytical skills are required. Construction industry experience is preferred.

This is an onsite, in-office-based position and can be based in our South Burlington, Vermont office, or one of our other regional offices located in Charlotte, NC, Atlanta, GA, or Alexandria, VA.

Key Responsibilities:
  • Track pipeline pursuits, review and analyze bid documents and specifications to identify insurance requirements. Obtain builderโ€™s risk, Ownerโ€™s protective, railroad protective and other project specific liability insurance coverage as necessary.
  • Review Owner Contracts, lease agreements, and equipment rental agreements to identify insurance requirements and request and issue insurance certificates on behalf of all PC Construction owned entities.
  • Identify and track subcontractor flow-down insurance requirements to support estimating, operations, and purchasing activities. Develop and maintain sample certificates of insurance for subcontractors and vendors to ensure consistency with contract requirements and facilitate bid package preparation and negotiations.
  • Communicate subcontractor and vendor insurance requirements to the third-party compliance vendor and review, evaluate, and approve exceptions as necessary.
  • Maintain and manage schedules of projects insured under the companyโ€™s master builderโ€™s risk program, including preparation of quarterly audit reports for the carrier. Separately, track and administer project-specific builderโ€™s risk policies, including monitoring insured limits and expiration dates and coordinating necessary adjustments such as limit increases and policy extensions.
  • Oversee and maintain comprehensive schedules of insurable assets, including all property locations, construction equipment, vehicles, trailers, drones, and other company-owned or operated assets.
  • Maintain and manage schedules of riggersโ€™ liability exposures, ensuring accurate tracking of values and locations.
  • Review Owner Controlled Insurance Program (OCIP) and Contractor Controlled Insurance Program (CCIP) manuals prior to project start-up and advise project teams on the scope of coverage, exclusions, and operational requirements under each program. Oversee program administrators to ensure all subcontractors are properly enrolled or excluded, as applicable, prior to commencing on-site work. Validate enrollment documentation, confirm compliance with program requirements, and verify that certificates of insurance are obtained and maintained for all off-site exposures not covered by the OCIP or CCIP.
  • Work collaboratively with project teams to evaluate and track subcontractor eligibility for the SDI program, complete enrollment forms, and manage ongoing quarterly reporting requirements to support program compliance.
  • Partner with the Corporate Safety Department to develop and maintain compliant workersโ€™ compensation physician panels in applicable states, including coordinating with carriers/brokers, verifying state-specific posting and notice requirements, and supporting project teams with implementation and ongoing compliance.
  • Administer workersโ€™ compensation return-to-work protocols, including issuing notice letters for light duty and return-to-full-duty status, coordinating with adjusters and medical providers, and maintaining documentation to support effective claim management.
  • Oversees requests for MVRs (Motor Vehicle Records) for driver authorizations and in conjunction with pending vehicle assignments; reviews results and advises the Director of Risk Management of any concerns. Conducts annual MVR audits and oversees tracking of personal auto certificates of insurance (COIs) for allowance drivers to ensure compliance with minimum required limits and coverage standards.
  • Process all departmental invoices in alignment with the appropriate project/department phase.
  • Maintain a strong relationship with insurance and surety broker partners to ensure the efficiency of program administration functions, program invoicing, policy issuance, and certificate of insurance requests.
  • Coordinate underwriting details for renewals providing accurate and organized information.
  • Participate/lead training with Operations Teams.
100% EMPLOYEE OWNED

PC Construction is an Equal Opportunity Employer that values and respects the importance of a diverse and inclusive workforce.

About PC Construction:

PC offers general contracting, construction management and design-build services to private and public clients across the country. The company manages projects along the east coast from its headquarters in Vermont and a network of locations in Florida, Georgia, Maine, New Hampshire, New York, North Carolina and the Mid-Atlantic. From specialized buildings to complex water and wastewater treatment plants, PC is ranked annually as one of the top contractors in the country. A construction industry leader for over 65 years, PC Construction is guided to success by its team of dedicated employee-owners. #LI-AL1 #LI-ONSITE

This position has a pay range of $119,000 to $130,000 annually, depending on experience, in addition to an extensive benefits package that includes company stock and a profit-sharing bonus.

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