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Remote Risk Adjustment Auditor Jobs in Texas (NOW HIRING)

CERiS

Itemization Review Team Lead

Fort Worth, TX · Remote

$66K - $101K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Maintains Q&A support for the ... Experience in medical bill auditing preferred but not mandatory PAY RANGE: CorVel uses a market ...

CERiS

Itemization Review Nurse II

Fort Worth, TX · Remote

$61K - $98K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Collects supporting data and ... Experience in medical bill auditing preferred but not mandatory PAY RANGE: CorVel uses a market ...

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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 Texas?

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

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

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

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

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

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

Cities in Texas 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 Texas as of August 2026, with employment types broken down into 88% Full Time, 4% Part Time, 4% Temporary, and 4% Contract. Highlights an 100% Remote job distribution.

Senior Manager - Revenue Cycle (Texas)

Astrana Health, Inc.

Houston, TX • On-site, Remote

$80K - $120K/yr

Full-time

Posted 4 days ago

Job description

Senior Manager - Revenue Cycle (Texas)
Department: Clinical Operations
Employment Type: Full Time
Location: 19500 HWY 249, Suite 570 Houston, TX 77070
Reporting To: Maya Minard
Compensation: $80,000 - $120,000 / year
Description
The Senior Manager of Revenue Cycle is responsible for leading end-to-end revenue cycle operations, including claims management, payment posting, denials and appeals, accounts receivable, and patient collections. You will partner closely with clinical teams, finance, and risk adjustment teams to optimize cash flow, reduce revenue leakage, improve billing accuracy, and ensure regulatory compliance. Planning, organizing, and influencing department activities while overseeing day-to-day operations to ensure accuracy in the billing processes. Monitor budget and utilize operational resources, participate in billing process improvement to maximize reimbursement.
What You'll Do
  • Oversee charge capture and reconciliation, claims submission and editing, payment posting and reconciliation, denial management and appeals, A/R management and collection, credit balance resolution
  • Evaluate current Athena hold rules for appropriateness and propose and implement changes where appropriate
  • Ensure accounts are billed accurately and timely by providing proactive oversight and direction for billing teams
  • Support accurate and timely month-end close activities
  • Report key KPIs to finance and market leadership including net collection rate, days in A/R, denial rate, clean claim rate, point-of-service collections, etc. Identify trends and operational deficiencies, implementing corrective action plans as necessary
  • Monitor and manage the billing staff regularly for work accuracy including charge retrieval, claims submissions and payment posting, holding team accountable for success
  • Maintain current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations, as well as all aspects of third-party reimbursement policies and practices
  • Understand the contract terms and ensure appropriate payment
  • Participate in the development and implementation of operating policies and procedures
  • Audit current procedures to monitor and improve the efficiency of revenue cycle operations

Qualifications
  • Bachelor's degree or equivalent education
  • 7+ years' experience in revenue cycle/healthcare
  • Billing: 3+ years' experience in a leadership role
  • Athena experience required
  • Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy and follow through
  • Proven history of proactively identifying, resolving, and escalating issues that impact business outcomes
  • Possess complete understanding of the billing/collection process to resolve complex, outstanding claims
  • Demonstrated strong and persuasive verbal, written, and interpersonal communication skills
  • Proven track record showing good decision-making skills based upon a mixture of analysis, experience, and judgment
  • Proven ability to work collaboratively in a team environment in a positive and professional manner
  • Demonstrated strong knowledge of commercial and/or regulatory claims billing including relevant Federal, State, and local laws and regulations and requirements
  • Strong knowledge of third-party reimbursement, government reimbursement regulations, third party and patient billing, managed care agreements, account follow-up, account resolution, and cash applications
  • Proven extensive knowledge of EDI billing systems and third-party payor billing process management

Environmental Job Requirements and Working Conditions
  • This is a remote position with occasional travel to the Houston and Beaumont locations as needed.
  • The national target pay range for this role is $80,000 - $120,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

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