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Remote Risk Adjustment Auditor Jobs in New York (NOW HIRING)

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Remote Role Responsibilities * Lead risk adjustment and HCC coding operations across Medicare Advantage , Medicaid , and ACA risk adjustment programs. * Evaluate AI-generated HCC coding assignments ...

EmblemHealth

Staff Actuary - Medicare

New York, NY · On-site +1

REMOTE Summary: * Provide the analytical resources necessary for the development of overall pricing ... Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ...

Onco360

Compliance Auditor

New Hyde Park, NY · Remote

$60K/yr

Remote opportunity! Some Travel required - see details below Starting Salary at $60,000 and up ... Assists in the development and maintenance of operations audit and/or risk assessment tools ...

York Risk Services

Attorney Auditor

New York, NY · Remote

$70K - $75K/yr

This is a fully remote position, and candidates residing in any of the 50 United States are encouraged to apply.** As an Attorney Auditor at Sedgwick, you'll have the opportunity to take on new ...

PF Concepts

Inpatient Coding Auditor

Paterson, NJ · Remote

$40 - $44/hr

Remote Job Summary: The Inpatient Coding Auditor is responsible for auditing inpatient coding and ... audit risk. Responsibilities include, but are not limited to: * Review entire medical record to ...

Mercor

CDI Leader - Clinical Documentation

New York, NY · Remote

$84/hr

... remote environment. Preferred * CCDS (Certified Clinical Documentation Specialist) or CDIP (Clinical Documentation Improvement Practitioner) credential. * Experience with HCC risk adjustment and ...

Urrly

VP, Strategic Accounts - Health Plans

New York, NY · Remote

$175K - $215K/yr

Remote, United States * Pay: $175,000-$215,000 base + bonus + equity * Schedule: Flexible and ... Strong understanding of value-based care, Medicare Advantage, risk adjustment, quality, or care-gap ...

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

HCC Coding Leader - Risk Adjustment

Mercor

New York, NY • Remote

$110/hr

Full-time

Re-posted 4 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Risk-adjustment / HCC coding leader
Type: Contract
Compensation: $110/hour
Location: Remote

Role Responsibilities

  • Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA risk adjustment programs.
  • Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and regulatory compliance.
  • Review medical records to ensure complete and accurate capture of HCC-eligible conditions supported by clinical documentation.
  • Conduct and oversee retrospective and prospective chart reviews for risk score optimization.
  • Manage RADV audit preparation and response processes.
  • Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.

Qualifications

Must-Have

  • 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 years in a leadership role.
  • Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies.
  • Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment.
  • Experience with RADV audit preparation and CMS compliance requirements.
  • Familiarity with RAPS and EDGE submission processes.
  • Exceptional written and verbal English communication skills.
  • High attention to detail with the ability to identify coding inaccuracies and documentation gaps in AI-generated outputs.

Preferred

  • CRC (Certified Risk Coder), CCS, CPC, or RHIA credential.
  • Experience with risk adjustment analytics platforms and chart retrieval systems.
  • Background in health plan, Medicare Advantage organisation, or value-based care setting.
  • Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content.
  • Experience presenting risk adjustment performance to actuarial or executive teams.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.