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Remote Risk Adjustment Auditor Jobs in Florida (NOW HIRING)

Phsorg

Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ... Analyze the impact of risk adjustment models, acuity shifts, redeterminations and eligibility churn ...

Verify

Certified Auditor

Sarasota, FL · Remote

Conduct on-site and remote audits of suppliers to verify compliance with AS9100 requirements ... Experience with risk-based auditing and process-based auditing techniques. Responsibilities Key ...

Verify

Certified Auditor

Sarasota, FL · Remote

Conduct on-site and remote audits of suppliers to verify compliance with AS9100 requirements ... Experience with risk-based auditing and process-based auditing techniques. Responsibilities Key ...

Verify Inc.

Certified Auditor

Sarasota, FL · Remote

Conduct on-site and remote audits of suppliers to verify compliance with AS9100 requirements ... Experience with risk-based auditing and process-based auditing techniques. Responsibilities Key ...

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Remote Risk Adjustment Auditor information

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 are the key skills and qualifications needed to thrive as a remote risk adjustment auditor?

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 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 Florida?

The most popular types of Risk Adjustment Auditor jobs in Florida are:

What are popular job titles related to Remote Risk Adjustment Auditor jobs in Florida?

For Remote Risk Adjustment Auditor jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Remote Risk Adjustment Auditor jobs in Florida look for?

The top searched job categories for Remote Risk Adjustment Auditor jobs in Florida are:

What cities in Florida are hiring for Remote Risk Adjustment Auditor jobs?

Cities in Florida with the most Remote Risk Adjustment Auditor job openings:

Remote Risk Adjustment Auditor jobs near you
Infographic showing various Remote Risk Adjustment Auditor job openings in Florida as of September 2026, with employment types broken down into 100% Full Time. Highlights an 25% Hybrid, and 75% Remote job distribution.

Coding Quality Assurance (QA) Manager, Remote

Fort Lauderdale, FL • On-site, Remote

Aledade PBC
See more jobs at Aledade PBCexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

Job description

As a Coding Quality Assurance (QA) Manager, you will lead a high-performing team of QA Specialists at the intersection of clinical precision and operational excellence. You'll drive coding accuracy, build robust Standard Operating Procedures (SOPs), and ensure full audit readiness by evaluating documentation from both our internal CDI team and external partners. If you bring deep expertise in Risk Adjustment and Hierarchical Condition Categories (HCC) alongside a passion for mentoring talent and elevating compliance standards, this role offers a direct platform to shape our quality operations and make a measurable impact.
 
Candidates should be comfortable working remotely from anywhere within the US, across all US time zones.
Primary Duties
  • Team Leadership & Oversight: Lead, mentor, and manage a team of  QA Specialists. Establish team goals, monitor productivity, conduct regular performance reviews, and foster a culture of continuous learning.
  • Quality Audits: Oversee and perform comprehensive quality assurance reviews for coding completed by internal CDI staff and external vendor partners, ensuring compliance with official ICD-10-CM guidelines and risk adjustment models.
  • SOP & Guideline Development: Design, implement, and maintain standard operating procedures, audit workflows, scoring methodologies, and coding quality guidelines across the organization.
  • Payer Audit Support: Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare, Commercial). Assist with chart selection, review, dispute documentation, and appeal responses.
  • Vendor Management: Evaluate third-party coding vendor accuracy rates against established SLAs. Deliver constructive feedback, identify trend errors, and drive corrective action plans when necessary.
  • Education & Feedback Loops: Translate QA audit findings into actionable insights. Provide structured feedback and target educational resources to internal CDI specialists and vendors to prevent recurring errors.
  • Other duties as assigned
Minimum Qualifications:
  • Bachelor's Degree in health care management, nursing or related field or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment required.
  • Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring.
  • Active professional credentials from AAPC and/or AHIMA required (such as CRC, CCS, CPC, or CPMA).
  • Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.
Preferred KSA's:
  • CRC (Certified Risk Adjustment Coder)
  • Experience working within Value-Based Care (VBC) models, ACOs, or Advantage plans.
  • Prior experience managing small teams or leading vendor oversight programs.
  • Exceptional leadership, communication, and organizational skills.
  • Proficiency with EHR systems and encoder software
Who We Are:
Aledade PBC, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
 
What Does This Mean for You?
At Aledade PBC, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
 
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
 
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
 
At Aledade PBC, we don't just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
 
 
We may use automated tools, including artificial intelligence (AI), to help organize and evaluate application materials. These tools support our recruiters and hiring managers by helping manage large applicant pools. Human judgment plays an essential role in our hiring process, including in the oversight and use of any automated tools. If you would like more information about our screening and hiring process, please contact us. Our Commitment to Authenticity. We use Endorsed, a fraud detection tool, to validate the authenticity of applications and protect against identity fraud. This ensures we are connecting with real people and allows us to prioritize genuine candidates. When you apply to a job on this site, the personal data contained in your application will be collected by Aledade PBC using Lever, a cloud services provider located in the United States. Lever is engaged by Aledade PBC to help manage its recruitment and hiring processes. For more information about how your personal data will be processed by Aledade PBC and any rights you may have, please review Aledade PBC's Candidate Privacy Notice. By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants If you have any questions about our privacy practices, please contact [email protected].
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