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Remote Risk Adjustment Auditor Jobs in Indiana (NOW HIRING)

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Business Analyst III

Martinsville, IN · Remote

$71K - $119K/yr

About the Business LexisNexis Risk Solutions is the essential partner in the assessment of risk ... Collaborate with remote development teams, internal IT, and business stakeholders to ensure ...

Manulife

$89K - $105K/yr

This is a remote role open to any location in continental US Manulife is a leading international ... May process all aspects of auditing, formal appeal reviews and contestable claim review. * Audit ...

CorVel

CareIQ Service Coordinator I

Carmel, IN · Remote

$15.61 - $23.82/hr

This is a remote role. The shift for this position is Monday - Friday: 10:30 AM - 7:00 PM EST. A ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

CareIQ Schedule Coordinator I

Carmel, IN · Remote

$15.61 - $23.82/hr

This is a remote position but for continuity of business with our management team, candidate needs ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

CareIQ Service Coordinator I

Carmel, IN · Remote

$15.61 - $23.82/hr

This is a remote role. The shift for this position is Monday - Friday: 10:30 AM - 7:00 PM EST. A ... The level may impact the salary range and these adjustments would be clarified during the offer ...

LogixHealth

Remote in AL, FL, GA, MA, MI, MO, NC, NH, OH, OK, TN, TX, WI, and WV This Role: We are seeking a ... high-risk employee interactions * Partner with managers and supervisors to coach on employee ...

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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 popular job titles related to Remote Risk Adjustment Auditor jobs in Indiana? For Remote Risk Adjustment Auditor jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Remote Risk Adjustment Auditor jobs in Indiana look for? The top searched job categories for Remote Risk Adjustment Auditor jobs in Indiana are:
What cities in Indiana are hiring for Remote Risk Adjustment Auditor jobs? Cities in Indiana with the most Remote Risk Adjustment Auditor job openings:
Remote Risk Adjustment Auditor jobs near you

DRG Coder, Registered Nurse

Pivotal Placement Services

Gary, IN • Remote

$95K - $105K/yr

Full-time

Posted 10 days ago

Job description

DRG Coder, Registered Nurse

📍 Remote | Full-Time | 🏥 Healthcare | Clinical Documentation & Coding

About the Role

We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment.

You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings.

Key ResponsibilitiesDRG Validation & Chart Review
  • Perform in-depth DRG quality audits of inpatient medical records.
  • Validate DRG assignments against clinical documentation and coding guidelines.
  • Identify missed opportunities, discrepancies, and documentation gaps impacting reimbursement.
Clinical Documentation Review
  • Evaluate physician documentation to ensure clinical indicators appropriately support assigned diagnoses and procedures.
  • Apply strong clinical judgment to assess severity of illness, risk of mortality, and DRG impact.
Audit & Compliance
  • Ensure compliance with Medicare, CMS, and payer-specific documentation and coding requirements.
  • Identify trends, risks, and improvement opportunities related to DRG accuracy and quality.
  • Support organizational initiatives focused on audit accuracy, compliance, and revenue integrity.
Coding Expertise
  • Apply extensive hands-on knowledge of ICD-10-CM and ICD-10-PCS, Coding Clinic guidance, and Official Coding Guidelines.
  • Utilize MS-DRG and APR-DRG methodologies when reviewing and validating records.
Communication & Reporting
  • Document audit findings clearly, concisely, and professionally.
  • Communicate results and rationale effectively to internal stakeholders as required.
Additional Duties
  • Support other documentation, coding, and audit-related activities as assigned.
Required QualificationsLicensure
  • Active Registered Nurse (RN) license required
    (Non-RN candidates will not be considered)
Experience
  • Minimum of 2 years of recent DRG quality auditing experience in a hospital or health plan setting.
  • Extensive hands-on inpatient ICD-10-CM and ICD-10-PCS coding experience required.
Certifications
  • National coding certification required (AHIMA or AAPC).
  • CCS, CIC, or equivalent strongly preferred.
Technical Knowledge
  • Proficiency in Medicare and CMS documentation and coding guidelines.
  • Strong understanding of MS-DRG and APR-DRG methodologies.
  • Advanced familiarity with Coding Clinic citations and Official Coding Guidelines.
Soft Skills
  • Exceptional attention to detail and analytical accuracy.
  • Strong critical thinking and problem-solving skills.
  • Clear, professional written and verbal communication.
  • Ability to work independently in a fast-paced, production-driven environment.
Tools
  • Proficient in Microsoft Office Suite (Excel, Word, Outlook).
Compensation

💵 Pay Range: $90,000 – $104,841

Compensation is based on location, experience, qualifications, and internal equity. Final compensation may vary following the interview and assessment process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in healthcare talent—from frontline staff to executive leadership—in both clinical and non-clinical roles. We deliver customer-focused staffing solutions through Direct Placement and MSP/VMS partnerships nationwide.