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Remote Risk Adjustment Auditor Jobs in Indiana (NOW HIRING)

BSI Prof Serv EHS West

Remote, Northern Europe About the role We are looking for an Employee Relations Specialist to join ... risk, and drive consistency across Northern Europe. This is an excellent opportunity for someone ...

BSI Group

Remote, Northern Europe About the role We are looking for an Employee Relations Specialist to join ... risk, and drive consistency across Northern Europe. This is an excellent opportunity for someone ...

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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.

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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
Clinical Pharmacist (MTM) - Work From Home

Clinical Pharmacist (MTM) - Work From Home

Health Care Service Corporation

Indianapolis, IN • Remote

$102K - $184K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 22 days ago

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary(Healthspring)The Clinical Pharmacist plays a vital role in advancing the quality, safety, and effectiveness of drug therapy for Healthspring Medicare members. In this position, you will collaborate with a high performing, multidisciplinary team of professionals across multiple functions to conduct comprehensive medication reviews (CMRs) for high-risk populations. These reviews include but are not limited to the assessment of drug interactions, identifying therapeutic duplications, evaluating renal and hepatic dosing adjustments, addressing evidence-based gaps in care, supporting STAR-related pharmacy initiatives, and identifying barriers to medication affordability and adherence.

JOB REQUIREMENTS (MTM):

  • Active and unrestricted Pharmacist license in the State of residence required

  • Doctor of Pharmacy (PharmD) degree required

  • Strong clinical medication knowledge with the ability to apply evidence-based guidelines in practice

  • Minimum 3 years' experience in Managed Care, Medicare and/orMedicaid settingspreferred

  • Experience with Medication Therapy Management (MTM) programs strongly preferred

  • Familiarity with MTM platforms (ex: Adhere Health's Optimize or similar applications) preferred

  • Excellent verbal and written communication skills, with the ability to effectively engage diverse audiences

  • Bilingualproficiencyin English and Spanish

  • Advancedproficiencyin Microsoft Office applications including Word, Excel, PowerPoint, and Outlook

  • Strong computer literacy with the ability to navigate systems and applications simultaneously

  • Strong learning agility and ability to apply new concepts and tools

  • Strong analytical thinking, problemsolvingand clinical decision-making skills

  • Ability to develop innovative solutions to complex healthcare challenges

PREFERRED JOB REQUIREMENTS:

*Strong experience with MTM required

*Bilingual (English and Spanish preferred)
*Must be willing to work Phone Queue

*Must be clinically strong with experience in diverse programs (MTM, Case Referrals, Narcotics)
*Residency and/or Board Certification preferred

#LI-FW1

#LI-Remote
This is a Remote/Work-From-Home role. Must have an active and unrestricted Pharmacist licensein the State of residence.

Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$102,000.00 - $184,300.00

Exact compensation may vary based on skills, experience, and location.

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