Remote Risk Adjustment Auditor Jobs in Indiana (NOW HIRING)

Anticipated End Date:

Position Title:

Job Description:

Location: St Louis MO, Atlanta GA, Mason OH, Tampa FL, Grand Prairie TX, Overland park KS, Indianapolis IN

Hours: Standard Working hours

Travel: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Position Overview:

Provides oversight of medical record coding and documentation review activities to support compliance with federal requirements and medical documentation standards. Delivers audit findings and insights to healthcare providers and stakeholders, while supporting provider education initiatives focused on Medicare risk adjustment coding accuracy, documentation quality, and regulatory compliance.

How You Will Make an Impact:

• Serves as final arbiter regarding the Risk & Recovery's Retrospective Risk Adjustment (RA) Coding Team.

• Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements

• Collects and analyzes data to formulate recommendations and solutions based on trends and results

• Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps

• Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices

• Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education

• Assists the business with research and documentation of workflows and policies and procedures

Required Qualifications:

• Requires BA/BS in health sciences, health management, or nursing and minimum of 5 years of ICD-9 coding or medical record review experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.

• CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.

Preferred Qualifications:

• Experience with Medicare Advantage and risk adjustment programs, including HCC coding.

• Experience auditing physician, outpatient, and/or hospital medical records.

• Experience interpreting and applying ICD-10-CM, CPT, HCPCS, and CMS guidelines.

• Experience developing and delivering provider or staff education.

• Strong knowledge of:

  • CMS regulations and Medicare risk adjustment methodologies

  • Medical record documentation standards

  • Federal healthcare compliance requirements

  • Coding and reimbursement principles

• Ability to analyze audit findings, identify trends, and recommend corrective actions.

• Strong written and verbal communication skills, including the ability to present audit results and educate providers.

• Proficiency with Microsoft Office applications and reporting tools.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.