Radv Audit Jobs (NOW HIRING)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This is a remote position.
The Coding Analyst, CDO is a core member of the Care Delivery Organization's coding team, serving as both a hands-on HCC coder and a provider-facing enablement resource for Alignment's contracted physician and clinical partners. Working closely with clinical documentation teams, and CDO provider partners - including PCPs, specialists, and clinical support staff - this role delivers accurate HCC code assignments, conducts structured provider coding audits, and provides targeted education that improves documentation quality and risk capture at the point of care. The Coding Analyst's work directly drives RAF score accuracy, revenue integrity, and the quality of clinical documentation across the CDO's provider network, making this role both a production function and a trusted clinical partner in Alignment's Medicare Advantage operations.
Job Responsibilities:
Execute Accurate HCC Coding from Member Medical Records. Review prospective and retrospective member medical records and assign accurate, compliant HCC codes using ICD-10-CM coding guidelines to support CMS Risk Adjustment submissions.
Conduct Structured Provider Coding Audits. Perform structured audits of provider documentation and coding practices for assigned physician groups and clinical staff - identifying patterns of under-documentation, missed conditions, and coding inaccuracies, and delivering specific, actionable feedback that drives measurable and sustained improvement.
Deliver Provider-Facing Education and Training. Develop and deliver targeted education on coding standards, CMS Risk Adjustment requirements, and clinical documentation best practices - tailoring content to the needs of PCPs, specialists, and clinical support staff across assigned CDO provider groups.
Identify and Close Provider-Level Documentation Gaps. Flag unsupported diagnoses, incomplete clinical documentation, and missing eligible conditions - communicating findings directly to providers and care teams to close risk capture gaps at the source and reinforce documentation standards.
Ensure Compliance with CMS Coding Guidelines. Apply current CMS Risk Adjustment coding rules, Official Guidelines for Coding and Reporting, and organizational policies to all coding and provider education activities - minimizing audit risk and ensuring submission integrity.
Meet Productivity and Quality Standards. Achieve daily coding productivity targets and maintain quality scores at or above established benchmarks, contributing directly to the CDO's RAF accuracy and performance goals.
Maintain Current Knowledge of Coding and Regulatory Updates. Stay current on ICD-10-CM updates, CMS Risk Adjustment model changes, and HCC coding guidance - applying changes promptly to all coding work and updating provider education materials accordingly.
Support Data Integrity and Accurate Reporting. Ensure all coded data is entered accurately into applicable systems to support downstream risk adjustment reporting, encounter data submissions, and performance analytics used by CDO leadership
Other duties and projects not listed above
Supervisory Responsibilities:
Individual Contributor role.
Job Requirements:
Experience:
Required:

• Minimum 2 years of experience in medical coding, with direct experience in Risk Adjustment or HCC coding in a Medicare Advantage, managed care, or health plan environment
• Demonstrated experience with prospective and/or retrospective chart review coding
• Working knowledge of ICD-10-CM coding systems and CMS Risk Adjustment methodology
• Experience using electronic health record (EHR) systems and coding platforms

Preferred:

• Experience coding in a high-volume Medicare Advantage health plan or delegated risk model
• Familiarity with CMS RADV audit processes and encounter data submission requirements
• Experience with coding productivity and quality tracking tools

Education:
Required:

• High school diploma or equivalent required; associate's or bachelor's degree in Health Information Management, Medical Coding, or a related field preferred
• Equivalent combination of education and coding experience in Medicare Risk Adjustment will be considered

Preferred:

• Associate's or bachelor's degree in Health Information Management or a related field

Training:
Required:

• Formal training in ICD-10-CM coding and CMS Risk Adjustment methodology, through an accredited coding program or demonstrated equivalent experience

Preferred:

• AAPC or AHIMA-approved coding education or certification preparation coursework
• Continuing education in CMS HCC model updates and Risk Adjustment compliance

Specialized Skills:
Required:

• ICD-10-CM Coding (Proficient): Accurate application of ICD-10-CM diagnosis codes to medical records in compliance with Official Coding Guidelines and CMS Risk Adjustment rules.
• HCC Coding and Risk Adjustment Knowledge (Proficient): Working knowledge of the CMS-HCC Risk Adjustment model, hierarchical condition categories, and how diagnosis coding translates to RAF scores and plan revenue.
• Medical Record Review (Proficient): Ability to navigate and interpret clinical documentation across multiple record types - including physician notes, discharge summaries, and diagnostic reports - to identify codeable conditions.
• Coding Compliance and Audit Readiness (Proficient): Understanding of coding accuracy standards, documentation requirements, and CMS audit expectations - with the ability to identify and escalate non-compliant documentation.
• EHR and Coding System Proficiency (Working Knowledge): Competence with electronic health records and coding workflow platforms used to retrieve, review, and submit coded data.
• Attention to Detail and Productivity Management (Proficient): Ability to maintain high accuracy and consistent output in a remote, high-volume coding environment with independently managed workloads.
• Clinical Documentation Integrity Awareness (Working Knowledge): Familiarity with CDI principles and the ability to recognize documentation gaps that affect HCC capture and coding completeness.

Preferred:
Licensure:
Required:

• CPC (Certified Professional Coder) - AAPC; OR
• CCS (Certified Coding Specialist) - AHIMA; OR
• RHIT (Registered Health Information Technician) - AHIMA

Preferred:

• CRC (Certified Risk Adjustment Coder) - AAPC
• CDEO (Certified Documentation Expert Outpatient) - AAPC

Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $58,531.00 - $87,797.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com.