Remote Risk Adjustment Auditor Jobs in Virginia (NOW HIRING)

Relationship Management and Provider Support

• Be the primary contact for assigned IPA providers for all coding and documentation-related inquiries.

• Build consultative relationships with providers to support continuous improvement in coding accuracy and documentation practices.

• Deliver targeted education based on provider-specific trends and opportunities identified through chart reviews and coding analytics.

Quarterly Chart Reviews and Education

• Conduct quarterly chart reviews for assigned providers to evaluate coding accuracy, documentation integrity, and risk capture opportunities.

• Develop and deliver comprehensive education based on findings, including documentation best practices and coding optimization strategies.

• Identify trends and recurringgaps, andpartner with education and leadership teams to address systemic opportunities.

Coding Tools, Workflow Support, and Operations

• Support daily operations of internal coding solutions, including Annual Proof of Documentation (APD 2.0) and any future tools implemented based on organizational needs.

• Assist providers in navigating coding workflows, resolving issues, and ensuring successful use of coding tools.

• Monitor and support completion of coding activities tied to assigned providers.

IPA Coding Helpdesk Support

• Participate in a daily coder helpdesk (virtual/Zoom-based), providing real-time support to providers within assigned markets.

• Address immediate coding and documentation questions, ensuring accurate guidance.

• Maintain a high level of responsiveness and provider engagement.

HCC Outage and Recapture Support

• Support HCC outage management through structured reviews of "assessed but not coded" conditions.

• Conduct targeted reviews to identify missed coding opportunities and provide education to improve recapture performance.

• Collaborate with analytics and leadership teams to track and improve performance outcomes.

Required Qualifications:

• 3+ years of risk adjustment MedicalCodingor riskadjustmentProviderEducation

• Intermediate/advanced competency with MS Office based programs (Excel, Word, PowerPoint)

• Must be certified at least one of the following: CCS, CRC, or CPC

• Must resideand be able to travelwithin the assigned MSO market or region.

Preferred Qualifications:

• Strong communication and interpersonal skills are essential. These skills enable effective, clear, and sensitive engagement with clinicians and team members, even in high-pressure or stressful situations. They also facilitate presenting, influencing, and building credibility at all levels of the organization.

• Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and Education, PCO, and Humana teams.

Additional Information

• We ask that youhave the ability totravel locally for in-office provider support.

• Standard working hours required; based on market needs.

• Travel may be required based on provider engagement and business needs.

Work Information:

This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.

• Workstyle: Hybrid/remote

• Location:Must residewithin 50 milesof Chesapeake, Suffolk or Virginia Beach, Virginia

• Hours:Monday-Friday, 8:00 AM-5:00 PM; additional time may be required.

TB Statement:

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement:

This role is part of our company's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance.Individualmust carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Work at Home Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.