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Remote Risk Adjustment Auditor information

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

To thrive as a Remote Risk Adjustment Auditor, you need strong knowledge of medical coding (CPT, ICD-10), healthcare compliance, and experience with risk adjustment methodologies, typically supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic health record (EHR) systems, coding audit software, and secure remote work platforms is essential. Attention to detail, analytical thinking, and effective written communication are important soft skills for interpreting complex medical records and collaborating with healthcare providers. These skills ensure accurate risk adjustment coding, regulatory compliance, and optimized reimbursement processes in a remote work environment.

What are some common challenges Remote Risk Adjustment Auditors face, and how can they overcome them?

Remote Risk Adjustment Auditors often encounter challenges such as interpreting complex medical records, staying current with changing coding guidelines, and effectively communicating with team members in a virtual environment. To overcome these, auditors should prioritize ongoing education on coding standards, utilize secure collaboration tools to stay connected with colleagues, and develop strong organizational skills to manage multiple assignments efficiently. Proactively seeking feedback and participating in team meetings can also help maintain accuracy and a sense of community while working remotely.

What is a Remote Risk Adjustment Auditor?

A Remote Risk Adjustment Auditor is a healthcare professional who reviews medical records and documentation from a remote location to ensure accurate coding for risk adjustment purposes. Their work helps health plans and providers comply with government regulations and receive appropriate reimbursement for patient care. They analyze clinical documents to validate diagnoses, identify coding errors, and ensure data integrity. Remote auditors use specialized software and follow strict confidentiality guidelines while working from home or another offsite location.

What is the difference between Remote Risk Adjustment Auditor vs Remote Medical Coder?

AspectRemote Risk Adjustment AuditorRemote Medical Coder
CertificationsCPMA, RAC, or RHITAAPC CPC, CCS, or RHIT
Work EnvironmentInsurance, healthcare auditing firmsHospitals, clinics, insurance companies
Job FocusReviewing documentation for risk adjustment accuracyAssigning medical codes to patient records

Remote Risk Adjustment Auditors and Remote Medical Coders often share certifications and work in healthcare settings. However, auditors focus on reviewing documentation for risk adjustment purposes, while coders assign medical codes directly to patient records. Both roles require healthcare knowledge but serve different functions within the industry.

What are the most commonly searched types of Risk Adjustment Auditor jobs in California? The most popular types of Risk Adjustment Auditor jobs in California are:
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Remote Risk Adjustment Auditor jobs near you
Auditor, Risk Adjustment (Remote)

Auditor, Risk Adjustment (Remote)

Molina Healthcare

Long Beach, CA • Remote

Full-time

Posted 3 days ago

New

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

133rd of 281 rated insurance

Job description

JOB DESCRIPTION Job Summary

Provides audit support for Molina enterprise risk adjustment activities.  Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk, and estimates the potential financial consequences of an occurring loss.  Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.

Essential Job Duties

Facilitates daily operations of all aspects of risk adjustment data validation and audit-related activities, including but not limited to:  progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines.
Represents as a risk adjustment audit liaison with functional departments, health plans, and external vendors.
Evaluates results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans (CAPs) as necessary.
Oversees Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data transmissions, and assists in identification of issues that impact data integrity and accuracy.
Develops and implements processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data.
Identifies opportunities for data mining to ensure data gaps are minimized.
Applies best practices to ensure accuracy of risk adjustment payment in all markets.
Supports all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met.
Performs monthly audits on internal Molina coding specialist performance..
Facilitates audits on external Molina vendor performance.
 

Required Qualifications

At least 3 years of coding, medical record chart review, and risk adjustment data validation experience, or equivalent combination of relevant education and experience.
Certified Coding Specialist (CCS), Certified Coding Specialist -Physician-based (CCS-P), or Certified Professional Coder (CPC).
Excellent attention to detail, documentation and organizational skills.
Critical-thinking, problem-solving and analytical skills.
Ability to work independently in a fast-paced, deadline-driven environment.
Ability to work cross-collaboratively in a highly matrixed environment, including ability to communicate audit findings with internal teams.  
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferences:

Certified Risk Adjustment Coder (CRC). 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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