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Risk Adjustment Auditor Jobs (NOW HIRING)

Centene Corp.

$56 - $101/hr

Work on additional risk adjustment audit requests (i.e. outside auditors' requests). * Serve on the RADV Committee as subject matter experts. * Perform quality assurance auditing (i.e. ensure ...

New

Centene

Risk Adjustment Auditor Educator

$56K - $101K/yr

Works on additional risk adjustment audit requests (i.e. outside auditors' requests). * Serves on the RADV Committee as subject matter experts. * Perform quality assurance auditing (i.e. ensure ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$30 - $35/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$27 - $30.75/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$27 - $30.75/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

Vytwo

Risk Adjustment Coding Auditor

Prosper, TX · On-site

$25 - $28.50/hr

Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV'

Vytwo

Risk Adjustment Coding Auditor

Dallas, TX · On-site

$60 - $90/hr

Risk Adjustment Coding Auditor. Quantity of resources: 2. Duration: 6 months. JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS ...

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Build the roadmap for the health plan's risk adjustment goals to improve data collection, reporting, and auditing. * Track risk scores and work closely with Actuaries and Financial Planning ...

Datavant

Auditor, HCC Risk Adjustment Coding

$28 - $31.75/hr

... Auditor you will review medical records that have been coded in a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will ...

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Risk Adjustment Auditor information

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How much do risk adjustment auditor jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for risk adjustment auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.

What is a risk adjustment auditor?

A Risk Adjustment Auditor reviews medical records to ensure accurate diagnosis coding for reimbursement and compliance with healthcare regulations. They validate that reported diagnoses reflect the patient's health status and meet federal and state guidelines. Their work supports proper risk adjustment payments in value-based care programs like Medicare Advantage. Strong knowledge of ICD-10 coding, CMS/HHS guidelines, and auditing procedures is essential.

What are the typical day-to-day responsibilities of a risk adjustment auditor?

As a Risk Adjustment Auditor, your daily tasks often include reviewing medical records for coding accuracy, ensuring proper documentation to support diagnosis codes, and identifying opportunities for improvement in risk adjustment processes. You may collaborate closely with coding teams, healthcare providers, and compliance staff to clarify ambiguities and provide feedback or training as needed. Regular responsibilities also involve preparing audit reports, tracking findings, and staying updated on changes in coding guidelines and regulations. This role is detail-oriented and requires precise analysis to ensure that healthcare organizations receive appropriate reimbursements while maintaining regulatory compliance.

What are the key skills and qualifications needed to thrive in the risk adjustment auditor position, and why are they important?

To thrive as a Risk Adjustment Auditor, you need a strong background in medical coding, healthcare compliance, and health information management, often supported by certifications such as CRC (Certified Risk Adjustment Coder) or CPC (Certified Professional Coder). Familiarity with data analysis tools, EHR (Electronic Health Record) systems, and audit management software is typically required. Attention to detail, critical thinking, and effective communication are essential soft skills for ensuring accurate and thorough audits. These competencies are crucial for maintaining compliance, maximizing accurate reimbursements, and supporting quality improvement in healthcare organizations.

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Risk Adjustment Auditor jobs near you
Infographic showing various Risk Adjustment Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

Risk Adjustment - Risk Adjustment Coding Auditor 135-2014

CommunityCare

Tulsa, OK • On-site

$25 - $28.25/hr

Full-time

Re-posted 6 days ago

Job description

JOB SUMMARY:
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.
KEY RESPONSIBILITIES:
• Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.
• Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.
• Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.
• Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
• Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.
• Track and report audit results, trends, and performance metrics.
• Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy.
• Assist with education and training initiatives related to risk adjustment and documentation best practices.
• Maintain confidentiality and ensure compliance with HIPAA regulations.
• Meet daily and weekly productivity goals and quality standards set by the supervisor.
• Perform other job-related duties as required or assigned.
QUALIFICATIONS:
• Knowledge of CMS-HCC and HHS-HCC risk adjustment model.
• Knowledge of ICD-10-CM coding guidelines.
• Knowledge of RADV requirements.
• Proficiency in EMR systems and Microsoft Office (Excel preferred).
• High attention to detail.
• Strong analytical and critical thinking skills.
• Clear written and verbal communication.
• Ability to work independently and meet deadlines.
• Strong organizational skills.
• Integrity and commitment to compliance.
• Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
• A minimum of two years of risk adjustment coding or auditing experience.
• Experience reviewing medical records across multiple specialties.
• Certified Professional Coder (CPC), CRC, CCS, or equivalent coding certification.
• Bachelor's degree in Health Information Management or related field preferred.
• Previous auditing experience in Medicare Advantage and ACA preferred.
• Experience with internal audit programs or payer audits preferred.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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