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Remote Risk Adjustment Auditor Jobs in Pennsylvania

Erm

Lead Auditor

Pittsburgh, PA · Remote

This remote, work-from-home role offers significant client engagement, international exposure, and ... Provide objective, credible assessments that support compliance, risk management, and continuous ...

Erm

Lead Auditor

Pittsburgh, PA · Remote

This remote, work-from-home role offers significant client engagement, international exposure, and ... Provide objective, credible assessments that support compliance, risk management, and continuous ...

Humana

Records Retrieval Specialist

Lancaster, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

York, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Harrisburg, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

York, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Mechanicsburg, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Harrisburg, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Carlisle, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Harrisburg, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Mechanicsburg, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

Humana

Records Retrieval Specialist

Carlisle, PA · Remote

$40K - $52K/yr

This is a remote role with field-based responsibility, requiring travel to provider offices to ... As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will: * Collect ...

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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 the most commonly searched types of Risk Adjustment Auditor jobs in Pennsylvania?

The most popular types of Risk Adjustment Auditor jobs in Pennsylvania are:

What are popular job titles related to Remote Risk Adjustment Auditor jobs in Pennsylvania?

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

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

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

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

Cities in Pennsylvania 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 Pennsylvania 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.

Regional Medical Director- (Philadelphia/Baltimore)

CareAllies

Philadelphia, PA • On-site, Remote

$191K - $355K/yr

Full-time

Medical, Life, Retirement, PTO

Re-posted 5 days ago

Job description

At CareAllies, 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.
Job Summary
This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives. Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.
Required Job Qualifications:
  • Physician with a current and unrestricted physician license in a state or territory of the United States.
  • Maintain Board Certification as a M.D. or D.O. (by a specialty board approved by the American Board of Medical Specialties (doctors of medicine); or the Advisory Board of Osteopathic Specialists (doctors of osteopathic medicine)
  • 5 years of clinical experience
  • Analytical and communication skills
  • Strategic thinking skills

Preferred Job Qualifications:
  • Ability to travel
  • 3 years Managed Care experience
  • IPA (independent Physician Association) MSO or Value Based Enablement Organization Experience
  • Advanced skills in clinical interpretation, communication, data-driven strategy, and collaborative leadership
  • Experience with Stars performance, risk adjustment education, or provider engagement
  • Experience in matrixed environments and cross-functional clinical leadership.

Remote work located in Philadelphia and Baltimore.
INAK
#LI-MG1
#LI-Remote
EEO 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.
Pay Transparency Statement:
At CareAllies, 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, a minimum of 15 days' of 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 full-time employees.
The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min to Max Range:
$191,500.00 - $355,600.00
Exact compensation may vary based on skills, experience, and location.

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