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Remote Risk Adjustment Auditor Jobs in Maryland (NOW HIRING)

Bcbsa

Financial Audit Senior Consultant

California, MD · On-site +1

$111K/yr

This role is responsible for monitoring, analyzing, and auditing financial transactions of high ... practices, and risk; and develop an overall and effective audit program. Develop and present ...

Bcbsa

Financial Audit Senior Consultant

Baltimore, MD · On-site +1

$115K/yr

This role is responsible for monitoring, analyzing, and auditing financial transactions of high ... practices, and risk; and develop an overall and effective audit program. Develop and present ...

Bcbsa

Financial Audit Senior Consultant

Gaithersburg, MD · Remote

$125K/yr

This role is responsible for monitoring, analyzing, and auditing financial transactions of high ... practices, and risk; and develop an overall and effective audit program. Develop and present ...

Bcbsa

$111K/yr

This role is responsible for monitoring, analyzing, and auditing financial transactions of high ... practices, and risk; and develop an overall and effective audit program. Develop and present ...

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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 popular job titles related to Remote Risk Adjustment Auditor jobs in Maryland?

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

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

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

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

Cities in Maryland 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 Maryland as of August 2026, with employment types broken down into 91% Full Time, 3% Part Time, and 6% Contract. Highlights an 100% Remote job distribution.

Financial Audit Senior Consultant

Bcbsa

California, MD • On-site, Remote

$111K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 4 days ago

Key responsibilities

  • Monitor, analyze, and evaluate financial transactions and data for accuracy, propriety, and compliance with policy requirements.

  • Lead financial audits/reviews to assess the accuracy of financial transactions and compliance with policies, supervising and training team members.

  • Evaluate compliance with regulations and develop corrective action plans, serving as the main contact for audits and maintaining the compliance plan.

Job description

This role is responsible for monitoring, analyzing, and auditing financial transactions of high complexity, and providing a leadership role. The role also evaluates compliance with regulations, develops corrective action plans, and delivers training to BCBSA and Plans. Additionally, the role involves acting as a resource and consultant on audit activities, developing programs, policies, and procedures to prevent abuse, and leading and supporting projects. The role frequently interacts with staff and management at varying levels within BCBSA, Plans, and a large banking institution.
  • Monitor, Analyze, and Evaluate Financial Transactions: Monitor, analyze, and evaluate assigned financial/accounting transactions and other financial data for accuracy, propriety, and compliance with policy requirements. Document and summarize activities and results in analyses and reports to department management.
  • Lead Financial Audits/Reviews: Lead approximately three to five financial audits/reviews per year (via desk or on-site) to determine the accuracy and propriety of Plans recorded financial transactions/reports and assess compliance with pertinent Policies. Supervise and train team members assigned to support these audits.
  • Evaluate Compliance and Develop Corrective Action Plans: Evaluate the level of compliance with applicable federal regulations, contractual requirements, and procedures at BCBSA and Plans. Maintain the BCBSA compliance plan and serve as the main point of contact for BCBSA and Plans financial and claims audits. Develop corrective action plans as needed.
  • Serve as Subject Matter Expert and Provide Training: Serve as subject matter expert for BCBSA financial policies and procedures regarding the audit process; instruct audit flow facilitation; analyze and assess audit trends, best practices, and risk; and develop an overall and effective audit program. Develop and present training to BCBSA and Plans as it relates to all types of audits.
  • Evaluate and Recommend Billing Rates: Evaluate Plan inter-Plan billing rate requests of high complexity levels and recommend rates to be approved to ensure billings/reimbursements between Plans are valid and for proper amounts.
  • Perform Complex Contract Administration Activities: Perform more complex activities relating to administration of the contract with a large banking institution and provide guidance to team members on their assignments. Ensure that BCBSA's transaction billings to Plans are correct and that the various transaction activity reports provided to the Plans meet their internal needs.

The posting range for this position is:

89,000.00 - 129,050.00


Qualifications:
Education

  • Required Bachelor's Degree in accounting, business, finance, or related field; or equivalent work experience

Experience

  • Required 5+ Years related work experience, including health insurance accounting, internal/financial auditing, general accounting, financial reporting, and project management


Knowledge Skills and Abilities

  • Effective written and verbal communication skills.
  • Demonstrated ability to build relationships with key resource people, whether internal or external.
  • Ability to train less experienced staff.
  • Advanced analytical skills and ability to frame issues and develop solutions.
  • Ability to work independently and manage time effectively.
  • Effective presentation skills and ability to adapt to changing priorities.
  • Intermediate knowledge of auditing, finance, and claims operations.
  • Advanced negotiation, analytical, and problem-solving skills.
  • Effective project management, interpersonal, and organizational skills.
  • Ability to develop and maintain business relationships and create strategies that support initiatives.


Certifications & Licenses

  • Preferred: Certified Public Accountant (CPA) - Various
  • Extra Posting Information:

    Minimum of five years of related work experience, including health insurance accounting, internal/financial auditing, general accounting, financial reporting, and project management. Experience with BCBS Inter-Plan Programs and proficiency with Microsoft Office Suite.

#LI-Remote

The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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