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Senior Risk Adjustment Auditor Jobs in Arizona (NOW HIRING)

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 ...

TEKsystems

Risk Adjustment Coding Auditor

Phoenix, AZ · Remote

$32 - $37/hr

Risk Adjustment Coding Auditor Overview We are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk ...

Viasat, Inc.

Senior Analyst, IT Risk & GRC

Tempe, AZ · On-site

What you'll do The IT Risk Senior Analyst is a strategic advisor responsible for integrating IT ris ... The ideal candidate possesses a strong blend of technical IT auditing skills, experience with ...

Fairygodboss

Risk Reporting - Vice President

Tempe, AZ · On-site

$120 - $160/hr

This includes executing key data integrity controls, reconciliations, adjustments, and analytics ... senior risk stakeholders before report distribution internally and to regulators. Job ...

American Express

Sr Technology Auditor

Phoenix, AZ · On-site

$78K - $124K/yr

Our assurance and risk professionals have diverse backgrounds including internal controls, consumer ... The Senior Technology Auditor role will audit technology and application controls integrated into ...

Honeywell - AEROSPACE

Sr Internal Auditor

Phoenix, AZ · Hybrid

$80K - $99K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

El Mirage, AZ · Hybrid

$79K - $99K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Phoenix, AZ · Hybrid

$83K - $104K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Phoenix, AZ · Hybrid

$83K - $104K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Peoria, AZ · Hybrid

$82K - $103K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Tolleson, AZ · Hybrid

$83K - $103K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Glendale, AZ · Hybrid

$84K - $104K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Phoenix, AZ · Hybrid

$83K - $104K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

Honeywell - AEROSPACE

Sr Internal Auditor

Paradise Valley, AZ · Hybrid

$85K - $105K/yr

As a Senior Internal Auditor here at Honeywell Aerospace, you will play a pivotal role in ensuring ... Develop and execute a risk-based internal audit plan, aligned with the risk assessment and company ...

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Senior Risk Adjustment Auditor information

What is a senior risk adjustment auditor?

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?

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.

What are the most commonly searched types of Risk Adjustment Auditor jobs in Arizona? The most popular types of Risk Adjustment Auditor jobs in Arizona are:
What are popular job titles related to Senior Risk Adjustment Auditor jobs in Arizona? For Senior Risk Adjustment Auditor jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Senior Risk Adjustment Auditor jobs in Arizona look for? The top searched job categories for Senior Risk Adjustment Auditor jobs in Arizona are:
What cities in Arizona are hiring for Senior Risk Adjustment Auditor jobs? Cities in Arizona with the most Senior Risk Adjustment Auditor job openings:
Senior Risk Adjustment Auditor jobs near you

Auditor, Risk Adjustment

Oscar Health

Tempe, AZ • Remote

$82K - $108K/yr

Full-time

Re-posted 12 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 304 rated insurance

Job description

Hi, we're Oscar. 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 serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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