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Remote Risk Adjustment Auditor Jobs in New Mexico

Claim.MD

Accounting Operations Manager

Pecos, NM · On-site +1

$90K - $105K/yr

Work Remotely - Opportunity to work in a remote-first environment * Paid-Time Off - Up to ten days ... Review and approve accounting treatment for billing adjustments, revenue corrections, and write ...

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

Remote Clinical Program and Population Health Strategist-Government Programs

Presbyterian Healthcare Services

Santa Fe, NM • On-site, Remote

$108K - $190K/yr

Full-time

Medical, Dental, Vision, Life

Posted 14 days ago

Presbyterian Healthcare Services rating

7.0

Company rating: 7.0 out of 10

Based on 162 frontline employees who took The Breakroom Quiz

413th of 887 rated healthcare providers

Job description

Location Address:
Remote OfficeSanta Fe, NM 87501
Compensation Pay Range:
Minimum Offer $108,680.00Maximum Offer $190,694.40Now Hiring: Remote Clinical Program and Population Health Strategist-Government Programs
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled Clinical Program and Population Health Strategist-Government Programs to join our team.Type of Opportunity: Full timeJob Exempt: YesJob is based: Remote Workers New MexicoWork Shift: Days (United States of America)
Responsibilities:
The Clinical Program & Population Health Strategist - Government Programs is responsible for advancing population health strategy for ACA, Medicaid, and Dual Eligible Special Needs Plan (D-SNP) populations. This role aligns with Presbyterian's integrated delivery system (IDS) model and Health Value strategy, partnering across the health plan, medical group, and care delivery system.
The Strategist translates enterprise population health priorities into product-specific strategies, clinical program designs, and a prioritized Clinical Initiative Portfolio. This role influences execution through cross-functional partnerships but does not directly manage program operations or vendor performance.
Some key responsibilities include:
Government Programs Population Health Strategy
  • Develop population health strategies for ACA, Medicaid, and D-SNP populations aligned with enterprise priorities
  • Identify high-impact opportunities to improve outcomes for complex and vulnerable populations
  • Ensure alignment with regulatory requirements and product-specific goals

  • Clinical Initiative Portfolio Strategy & Prioritization
  • Support development and refinement of the Clinical Initiative Portfolio
  • Partner with product owners and leadership to prioritize initiatives based on impact and ROI
  • Define success metrics aligned with HEDIS, Stars, risk adjustment, and utilization goals

  • Clinical Program Design & Strategic Guidance
  • Design evidence-based clinical programs and interventions
  • Define target populations, program goals, and success measures
  • Partner with program and operational leaders to support implementation and scaling
  • Inform build vs. buy decisions for clinical capabilities

  • Provider Strategy & Performance Enablement
  • Translate clinical strategies into provider-facing approaches
  • Support development of provider tools, workflows, and reporting
  • Provide input into value-based care models and provider performance strategies

  • Product & Cross-Functional Alignment
  • Serve as liaison to Government Programs teams
  • Ensure alignment between benefit design, clinical programs, and population health outcomes
  • Collaborate with analytics, network, and operations teams

  • Analytics & Insights
  • Partner with analytics teams to define measurement frameworks
  • Use data to identify trends, gaps, and opportunities
  • Translate insights into actionable recommendations

  • Regulatory & Compliance Strategy
  • Ensure strategies align with CMS and Medicaid requirements
  • Support audits, reporting, and program integrity efforts

  • Health Equity & Community Integration
  • Embed health equity into all strategies and program designs
  • Identify disparities and recommend targeted interventions
  • Partner with community organizations and internal teams
  • Medicare Stars and HEDIS performance
  • Medicaid quality measures
  • Gap closure and preventive care utilization
  • Total cost of care and utilization trends
  • Clinical Initiative Portfolio performance and ROI
  • Health equity outcome measures
  • Reports to: Vice President, Population Health, Provider Strategy and Performance
  • Key partnerships: Government Programs Product Owners, Provider Strategy, Analytics, Network Management, Compliance, Community Health
  • Collaborates across Presbyterian Health Plan and Medical Group

Qualifications:
  • Bachelor's degree required; Master's degree (MPH, MHA, MBA, or related) preferred
  • 5-10+ years of experience in population health, healthcare strategy, or clinical program design
  • Experience with Medicare (D-SNP) and/or Medicaid programs
  • Strong understanding of HEDIS, Stars, risk adjustment, and utilization drivers
  • Experience working in a matrixed organization
  • Strategic thinking and portfolio prioritization
  • Clinical program design and innovation
  • Data-driven decision making
  • Cross-functional collaboration and influence
  • Strong communication and executive presence
  • Health equity focus

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

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About Presbyterian Healthcare Services

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Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Albuquerque, NM, US

Year founded

1908

Social media

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