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Senior Risk Adjustment Auditor Jobs (NOW HIRING)

Honest Health

Sr. Risk Adjustment Auditor

$82K - $101K/yr

Your Role The Risk Adjustment Auditor is a key contributor within the Clinical Documentation Integrity (CDI) program, responsible for ensuring the accuracy, completeness, and compliance of risk ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on ...

Stanford Health Care

Sr Risk Adjustment Coder

Newark, NJ

$44.13 - $57.36/hr

The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare ...

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 ...

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'

Solis Health Plans

MRA Auditor

Miami, FL · On-site

$68K - $73K/yr

The Medicare Risk Adjustment (MRA) Auditor is responsible for reviewing medical records, disease state documentation practices, encounter data submission processes, practice management code data and ...

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Senior Risk Adjustment Auditor information

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

As of Jul 20, 2026, the average yearly pay for senior risk adjustment auditor in the United States is $90,973.00, according to ZipRecruiter salary data. Most workers in this role earn between $81,000.00 and $99,500.00 per year, depending on experience, location, and employer.

What are Senior Risk Adjustment Auditors?

Senior Risk Adjustment Auditors are experienced professionals who review medical records and data to ensure accurate coding and documentation for risk adjustment purposes, primarily in healthcare settings. They help organizations comply with government regulations and maximize appropriate reimbursement by identifying and correcting coding errors or gaps. Their role involves analyzing patient data, collaborating with coding teams, and providing feedback or training to improve documentation practices. Senior auditors often have advanced knowledge of ICD-10-CM coding, risk adjustment models (such as HCC), and auditing standards. Their expertise helps healthcare organizations maintain compliance and optimize financial performance.

How does a Senior Risk Adjustment Auditor typically collaborate with coding teams and healthcare providers to ensure accurate documentation and coding?

A Senior Risk Adjustment Auditor often works closely with medical coding teams and healthcare providers to review patient records for accuracy and compliance with risk adjustment guidelines. This collaboration may involve providing feedback on documentation quality, clarifying coding ambiguities, and offering training or guidance on best practices. Regular meetings and audits help ensure that everyone is aligned with current regulations and organizational standards. Effective communication and teamwork are essential to maintain high-quality, compliant coding that supports proper reimbursement and patient care.

What are the key skills and qualifications needed to thrive as a Senior Risk Adjustment Auditor, and why are they important?

To thrive as a Senior Risk Adjustment Auditor, you need deep expertise in medical coding (ICD-10-CM), risk adjustment methodologies, and a background in healthcare compliance, typically supported by certifications such as CRC, CPC, or CCS-P. Familiarity with auditing platforms, data analysis tools, and electronic medical records systems is crucial. Exceptional attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and effectively collaborate with providers. These competencies ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

What is the difference between Senior Risk Adjustment Auditor vs Risk Adjustment Auditor?

AspectSenior Risk Adjustment AuditorRisk Adjustment Auditor
CertificationsCPMA, RAC, or similarCPMA, RAC, or similar
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsHealthcare providers, insurance companies, auditing firms
Job ResponsibilitiesLeading audits, mentoring, complex data analysisPerforming audits, data review, compliance checks

Both roles require similar certifications and work in healthcare or insurance settings. The Senior Risk Adjustment Auditor typically handles more complex audits, provides mentorship, and takes on leadership tasks, whereas the Risk Adjustment Auditor focuses on executing audits and data analysis. The senior role involves greater responsibility and expertise, often leading to career advancement in risk adjustment auditing.

More about Senior Risk Adjustment Auditor jobs
What cities are hiring for Senior Risk Adjustment Auditor jobs? Cities with the most Senior 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 Senior Risk Adjustment Auditor jobs? States with the most job openings for Senior Risk Adjustment Auditor jobs include:
What job categories do people searching Senior Risk Adjustment Auditor jobs look for? The top searched job categories for Senior Risk Adjustment Auditor jobs are:
Senior Risk Adjustment Auditor jobs near you
Infographic showing various Senior Risk Adjustment Auditor job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $90,973 per year, or $43.7 per hour.

Sr. Risk Adjustment Auditor

Honest Health

Remote

$82K - $101K/yr

Full-time

Posted 23 days ago

Job description

Who You Are
You're a collaborative professional, driven by the potential to make a meaningful impact in healthcare. The challenges of healthcare don't deter you-instead, you see them as opportunities to find innovative solutions that benefit the partners, people, and communities we serve. Honest Health's commitment to purpose, innovation, communities, and kindness resonates with you, inspiring you to bring commitment, creativity, and compassion into your work. You're ready to join a team focused on reimagining primary care for a healthier future that benefits all.
Does this sound like you? Let's connect.
Who We Are
At Honest Health, we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholders-from health systems, physician organizations, and payers to providers, practices, and patients - to deliver innovative solutions that elevate care, control costs, and support long-term health. Guided by our core values, we're creating a value-driven model that creates lasting benefits for everyone, now and into the future.
For us, that's just an Honest day's work.
Your Role
The Risk Adjustment Auditor is a key contributor within the Clinical Documentation Integrity (CDI) program, responsible for ensuring the accuracy, completeness, and compliance of risk adjustment coding and documentation across both internal teams and third-party vendors.
This role operates across concurrent and retrospective review workflows, auditing clinical documentation, coded data, and claims to verify adherence to ICD-10-CM guidelines, CMS Medicare risk adjustment requirements, MEAT criteria, and HCC capture standards. The Auditor serves as a quality control function for both vendor-delivered and internally produced CDI work, identifying gaps, validating accuracy, and driving continuous improvement.
In addition to audit responsibilities, this role plays a critical part in translating findings into actionable insights, supporting provider education, influencing documentation practices, and strengthening overall program performance.
Primary Functions of the Risk Adjustment Auditor Include:
  • Audit third-party vendor coding and CDI outputs to ensure accuracy, compliance, and adherence to contracted performance standards
  • Audit internal CDI Specialist I and II work, including chart reviews, queries, and reconciliation activities
  • Identify coding inaccuracies, unsupported diagnoses, missed HCC opportunities, and documentation gaps
  • Deliver audit findings, trend analysis, and corrective action recommendations to CDI leadership and vendor partners
  • Track and report audit performance metrics to support continuous quality improvement initiatives.
  • Review completed encounters in the post-visit, pre-billing window to validate documentation completeness and coding accuracy
  • Review and audit Pre-visit plan coding and CDI
  • Evaluate alignment between medical record documentation and draft claims, ensuring proper HCC capture
  • Assess each diagnosis for appropriate ICD-10-CM specificity and MEAT criteria compliance
  • Prioritize high-impact conditions and risk-adjustable diagnoses for intervention and resolution
  • Ensure compliant query practices aligned with AHIMA and ACDIS standards
  • Review query quality, provider responses, and documentation updates to confirm clinical support for diagnoses
  • Validate final alignment between documentation and submitted claims, resolving discrepancies in partnership with coding and billing teams
  • Translate audit findings into targeted provider and team education on documentation, coding specificity, and risk adjustment compliance
  • Partner with CDI, coding, and leadership teams to improve workflows, policies, and audit readiness
  • Serve as a subject matter expert and resource on risk adjustment, CDI best practices, and audit standards
  • Support the evolution of CDI and audit processes as automation, EMR integrations, and vendor models mature
  • Identify opportunities to expand audit scope (e.g., documentation patterns, provider performance trends, process inefficiencies)
  • Contribute to the development of scalable audit frameworks and quality assurance methodologies
  • Deliver real-time and aggregate coding and documentation feedback to providers and their clinical support teams
  • Design and facilitate education sessions on ICD-10-CM specificity, chronic condition documentation, HCC coding, and risk adjustment compliance both virtually and, on occasion, in person
  • Perform other related responsibilities as assigned

How You Qualify
You reviewed the Who You Are section of this job posting and immediately felt the need to read on. This makes you a match for our innovative culture. You accept things change quickly in a startup environment and are willing to pivot quickly on priorities.
  • Associate's or Bachelor's degree in Health Information Management, Nursing, or a related clinical field (or equivalent experience)
  • 5+ years of experience in risk adjustment, medical coding, CDI, or auditing
  • 2+ years of experience in prospective and concurrent review risk adjustment coding and auditing
  • Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding required
  • Experience auditing vendor-delivered work and/or CDI programs preferred
  • One or more of the following certifications:
  • CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) are required
  • CCS (Certified Coding Specialist) or CCDS (Certified Clinical Documentation Specialist) is preferred
  • RHIT/RHIA is preferred
  • Advanced knowledge of ICD-10-CM Official Guidelines and AHA Coding Clinic guidance
  • Advanced technical expertise in risk adjustment and coding compliance
  • Strong understanding of CMS risk adjustment methodologies and HCC models
  • Expertise in MEAT criteria application and compliant query practices
  • Familiarity with CDI workflows, EMR systems, and coding/audit tools
  • Strong analytical skills with the ability to identify patterns, risks, and improvement opportunities
  • High attention to detail and commitment to accuracy and compliance
  • Ability to collaborate effectively across CDI, coding, vendor management, and provider teams
  • Ability to translate complex audit findings into clear, actionable insights
  • Effective communication and collaboration skills across clinical and non-clinical stakeholders
  • Ability to manage multiple priorities in a fast-paced, evolving environment
  • Ability to work independently in a remote environment
  • Willingness to travel up to 25% for provider education or team collaboration
  • Commitment to maintaining confidentiality and compliance with all regulatory requirements

The base pay range for this role is $76,600.00 - $88,899.00. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, and organizational needs. Base pay is just one piece of the total rewards program offered by Honest. Eligible roles also qualify for short-term incentives and a comprehensive benefits package.
Honest Health is committed to ensuring fairness, opportunity, strong teams, and full integration of team members into the organization. We take proactive steps to ensure all applicants are considered for employment based on merit, without regard to race, color, religion, sex, national origin, disability, Veteran status, or other legally-protected characteristics.
Honest Health is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email talent@Honesthealth.com for assistance. Reasonable accommodation will be determined on a case-by-case basis.

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