ZipRecruiter

Log In

2

Remote Risk Adjustment Auditor Jobs (NOW HIRING)

Aledade

Vice President, Risk Adjustment, Remote

Arlington, VA · Remote

$145K - $194K/yr

... auditors and other relevant personnel, providing guidance and expertise on risk assessment ... remote-first culture - you've come to the right place. What Does This Mean for You? At Aledade, you ...

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

... on-site, remote and/or in-house) in support of the Medicare risk adjustment retrospective ... Coordinate with third party and internal auditors as required. * Other duties and projects as ...

Altegra Health

Remote Certified Coder

Atlantic City, NJ · Remote

$22.50 - $31/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

Altegra Health

Remote Certified Coder

Dallas, TX · Remote

$22.25 - $30.50/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

Altegra Health

Remote Certified Coder

Atlantic City, NJ · On-site +1

$22.50 - $31/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

Altegra Health

Remote Certified Coders

Memphis, TN · Remote

$21.75 - $29.75/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

Altegra Health

Remote Certified Coder

Dallas, TX · On-site +1

$22.25 - $30.50/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

Altegra Health

Remote Certified Coders

Memphis, TN · On-site +1

$21.75 - $29.75/hr

Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...

next page

Showing results 1-20

All JobsRisk Adjustment Auditor JobsRemote Risk Adjustment Auditor Jobs

Remote Risk Adjustment Auditor information

See salary details

$30.5K

$72.6K

$117.5K

How much do remote risk adjustment auditor jobs pay per year?

As of Jun 8, 2026, the average yearly pay for remote risk adjustment auditor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

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.

More about Remote Risk Adjustment Auditor jobs
What cities are hiring for Remote Risk Adjustment Auditor jobs? Cities with the most Remote Risk Adjustment Auditor job openings:
What are the most commonly searched types of Risk Adjustment Auditor jobs? The most popular types of Risk Adjustment Auditor jobs are:
What states have the most Remote Risk Adjustment Auditor jobs? States with the most job openings for Remote Risk Adjustment Auditor jobs include:
What job categories do people searching Remote Risk Adjustment Auditor jobs look for? The top searched job categories for Remote Risk Adjustment Auditor jobs are:
Remote Risk Adjustment Auditor jobs near you

Sr. Director, Risk Adjustment Data & Analytics

Alignment Healthcare

Remote

Full-time

Posted 10 days ago

Alignment Healthcare rating

7.3

Company rating: 7.3 out of 10

Based on 16 frontline employees who took The Breakroom Quiz

207th of 260 rated insurance

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Sr. Director, Risk Adjustment Data & Analytics (Remote) is a senior technical and operational leader responsible for advancing the integrity, completeness, and strategic value of Medicare Risk Adjustment (MRA) data and analytics programs within the organization. This role serves as the primary accountable leader for MRA data operations - owning the analytical and data engineering infrastructure that enables suspecting, chart review, coding, submission, and reconciliation workflows to operate at scale.
Working cross-functionally with MRA Business leadership, Finance, Actuarial, Clinical Operations, Compliance, and enterprise IT teams, this leader ensures that all key stakeholders are working from consistent, trusted, and defensible MRA data. The role leads a multidisciplinary team of analysts, data scientists, and data engineers, setting analytical standards and translating program outcomes into clear, actionable insights for senior leadership.
This role is critical to the organization because Risk Adjustment Factor (RAF) scores directly drive plan revenue, making accurate, timely, and defensible MRA data a high-stakes organizational priority - and the Senior Director is the operational owner of that capability.
Job Duties & Responsibilities
  • Lead MRA Data Operations and Ecosystem Quality. Own the end-to-end MRA data ecosystem - spanning data ingestion, transformation, validation, reporting, and analytics across all Risk Adjustment programs. Ensure data is timely, complete, and consistently reliable to support all downstream MRA workflows, from prospective suspecting through CMS submission and reconciliation.

  • Drive Analytical Insights and Program Performance Reporting. Develop and maintain reporting and analytical frameworks that explain what happened, why it happened, and where to intervene across MRA programs. Translate risk score trends, program impacts, and variance drivers into clear, executive-ready narratives and data visualizations that enable confident decision-making.

  • Ensure Audit Readiness, Data Governance, and Compliance. Establish and maintain rigorous data governance standards, controls, and documentation to ensure MRA data is audit-ready, reproducible, and defensible at all times. Partner closely with Compliance to support RADV audits, internal reviews, and CMS regulatory requirements - including full traceability of submissions and supporting evidence.

  • Partner Strategically with Finance, Actuarial, and Clinical Stakeholders. Serve as the primary MRA data partner to Finance and Actuarial teams, providing clarity on risk adjustment program performance, revenue impacts, and variance drivers. Support Clinical Operations and JSA Outreach teams with data that enables precise member identification, chart retrieval coordination, and coding accuracy.

  • Direct and Develop the MRA Analytics Team. Lead, grow, and develop a multidisciplinary MRA data team spanning analytics, data science, and data engineering disciplines. Establish clear accountability structures, promote a culture of quality and continuous improvement, and ensure team outputs meet the technical and operational standards required for a highly regulated environment.

  • Identify and Remediate Data Quality and Process Gaps. Proactively identify gaps in data quality, timeliness, or workflow execution and drive corrective actions through system improvements, tooling enhancements, or process redesign. Set and enforce technical and analytical standards - including definitions, assumptions, and validation checks - across all MRA data outputs.

Supervisory Responsibilities
This role is a people manager responsible for leading the MRA Data & Analytics team, which may include Analysts, Data Scientists, and Data Engineers. The Senior Director is accountable for building team capacity, setting performance standards, and developing talent to meet current and future program needs.
Supervisory Requirements: Fulfill supervisory responsibilities in accordance with organization policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Job Requirements
Experience
Required:
  • 7-10 years of progressive experience in healthcare data, analytics, or data operations, with direct, hands-on experience supporting Medicare Advantage Risk Adjustment programs.

  • Demonstrated experience leading or managing data teams responsible for regulated, audit-sensitive data environments.

  • Proven experience partnering with cross-functional stakeholders including clinical, finance, actuarial, and compliance teams.

  • Demonstrated ownership of complex, end-to-end data pipelines and analytical outputs in a healthcare or regulated industry setting.

  • Experience in a mid-to-large enterprise healthcare or health insurance environment, ideally a Medicare Advantage plan or managed care organization.

Preferred:
  • Experience building or scaling data and analytics functions within a health plan or insurance organization.

  • Experience working with chart retrieval vendors and provider partners to coordinate medical records access.

  • Experience implementing coding and auditing platforms (e.g., Episource, Veradigm, Cotiviti).

Education
Required:
  • Bachelor's degree in Health Informatics, Data Science, Statistics, Computer Science, Mathematics, Healthcare Administration, or a related quantitative field; or an equivalent combination of education, certification, and direct work experience.

Preferred:
  • Master's degree in Data Science, Health Informatics, Biostatistics, or a related field.

Training
Required:
  • No specific required certifications; demonstrated applied expertise in MRA data operations is essential.

Preferred:
  • Formal training in data governance frameworks, audit readiness methodologies, or advanced analytics (e.g., DAMA, CDMP, or equivalent).

  • Training in Medicare Advantage regulations, CMS reporting requirements (encounter data, RADV, HEDIS, STAR ratings, interoperability), and general health plan operations.

Required Skills & Competencies
Technical / Hard Skills
  • Medicare Risk Adjustment (MRA) Operations (Advanced) - Deep expertise in HCC coding, ICD-10 coding principles, RAF score calculation, CMS encounter data submission, and RADV audit requirements.

  • Data Analytics & Statistical Modeling (Advanced) - Strong analytical and modeling skills, including the ability to translate complex MRA program outcomes into quantitative metrics and executive-ready narratives.

  • Business Intelligence & Reporting Tools (Advanced) - Proficiency in Power BI, Tableau, or equivalent BI platforms; advanced spreadsheet modeling using Excel or Google Sheets.

  • SQL & Data Querying (Advanced) - Proficiency in SQL for data extraction, transformation, and analysis across large healthcare claims and encounter data sets; familiarity with Python or R is a plus.

  • Cloud & Data Platform Literacy (Advanced) - Familiarity with cloud data environments (Azure, AWS, GCP), data warehousing solutions, and integration with enterprise BI and analytics platforms.

Licensure
Required:
  • None required.

Preferred:
  • Certified Risk Adjustment Coder (CRC) issued by AAPC, or Certified Professional Coder (CPC); or relevant data science/analytics certifications (e.g., CDMP, Databricks, Microsoft Azure Data Fundamentals).

Pay Range: $198,219.00 - $297,329.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com.

What Alignment Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply