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Remote Risk Adjustment Auditor Jobs in Michigan (NOW HIRING)

Neogen

Head of IT Audit

Detroit, MI · On-site +1

Step into a high-impact leadership role where your expertise in IT audit, risk, and controls will ... Coordinate with external auditors to align IT audit activities, improve efficiency, and support ...

Neogen

Head of IT Audit

Birmingham, MI · On-site +1

Step into a high-impact leadership role where your expertise in IT audit, risk, and controls will ... Coordinate with external auditors to align IT audit activities, improve efficiency, and support ...

Motorola

... risk mitigation activities, with a primary focus on FedRAMP. Key Responsibilities: * Engage ... GIAC Systems and Network Auditor (GSNA) * GIAC Certified Intrusion Analyst (GCIA) * Certified ...

Bcbsa

Financial Audit Senior Consultant

Three Rivers, MI · Remote

$107K/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 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 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 the most commonly searched types of Risk Adjustment Auditor jobs in Michigan? The most popular types of Risk Adjustment Auditor jobs in Michigan are:
What are popular job titles related to Remote Risk Adjustment Auditor jobs in Michigan? For Remote Risk Adjustment Auditor jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Risk Adjustment Auditor jobs in Michigan look for? The top searched job categories for Remote Risk Adjustment Auditor jobs in Michigan are:
What cities in Michigan are hiring for Remote Risk Adjustment Auditor jobs? Cities in Michigan 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 Michigan 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.

Specialist, Health Plan Provider Engagement (Remote in MI)

Molina Healthcare

Detroit, MI • On-site, Remote

$45K - $88K/yr

Full-time

Medical

Posted 6 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 198 frontline employees who took The Breakroom Quiz

163rd of 304 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities. Focuses on smaller, less advanced Tier 2 and Tier 3 providers, ensuring they have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitate data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.
Essential Job Duties
  • Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
  • Ensures assigned Tier 2 and Tier 3 providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
  • Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
  • Works with provider front-office staff to get the Molina members with the most open gaps on the schedule seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side.
  • Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
  • Drives provider participation in Molina risk adjustment and quality efforts (e.g., supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
  • Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness both within and across Molina health plans.
  • Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.
  • Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues.
  • Accountable for use of standard Molina Provider Engagement reports and training materials.
  • Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by health plan and corporate policies.
  • Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within assigned provider practices.
  • Maintains the highest level of compliance.
  • May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.

Required Qualifications
  • At least 2 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, or equivalent combination of relevant education and experience.
  • Experience with various managed health care provider compensation methodologies including but not limited to fee-for service (FFS), value-based care (VBC), and capitation.
  • Working knowledge of quality metrics and risk adjustment practices across all business lines.
  • Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare, and Marketplace
  • Proficiency with data analysis, manipulation, interpretation, and reporting.
  • Critical-thinking, problem-solving, and analytical skills.
  • Relationship building skills.
  • Attention to detail and organizational skills.
  • Ability to implement process improvement initiatives and drive change.
  • Ability to work independently in a fast-paced, deadline-driven environment.
  • Ability to foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results.
  • Effective verbal and written communication skills.
  • Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications
  • Bachelor's degree in Nursing, Health Administration or relevant discipline.
  • Solid understanding of health insurance, provider messaging/design, and project management
  • Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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