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Senior Risk Adjustment Auditor Jobs in Michigan (NOW HIRING)

Mid - Senior Level Job type: Full time Industry: Financial Industry As Risk & Control manager you ... Financial, Sarbanes Oxley Act, SOX, AUDIT, Auditing, Risk, Controls, ITIL, IT control, Project ...

Senior Auditor

Grand Rapids, MI · On-site

$77K - $95K/yr

Development and maintenance of risk-based audittestingprograms in conjunction with an annual ... auditing and/or industry experience #LI-CH1 Candidates should be comfortable with an on-site ...

... risk based financial/operational audits and business consulting reviews. What you will do ... Assists in audit closing meetings with business area management, and as appropriate with senior ...

Technology Auditor

Dearborn, MI · Hybrid

$96K - $162K/yr

The Technology Senior Auditor will play a key role in the execution of the internal audit plan ... This role requires a strong understanding of risk management and internal controls, with a proven ...

Deep expertise in EHS auditing, compliance, and risk management systems * Strong executive presence with experience presenting to senior leadership and/or Board-level audiences * Experience ...

Senior Audit Consultant

Lansing, MI

$85K - $106K/yr

... auditors during their annual independent audits of the Company. Also, lead the department's testing of the model audit rule testing for the enterprise. * Perform risk assessment to identify high risk ...

Senior Audit Consultant

Lansing, MI · On-site

$85K - $106K/yr

... auditors during their annual independent audits of the Company. Also, lead the department's testing of the model audit rule testing for the enterprise. * Perform risk assessment to identify high risk ...

Deepexpertisein EHS auditing, compliance, and risk management systems * Strong executive presence with experience presenting to senior leadership and/or Board-level audiences * Experience integrating ...

Senior Audit Consultant

Detroit, MI

$83K - $103K/yr

Overview Corporate Audit and Advisory Services (CAAS) takes a proactive approach to auditing by ... Perform risk assessment to identify high risk business processes and apply relevant best practices.

Showing results 21-40

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 Michigan?

The most popular types of Risk Adjustment Auditor jobs in Michigan are:

What are popular job titles related to Senior Risk Adjustment Auditor jobs in Michigan?

For Senior Risk Adjustment Auditor jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Senior Risk Adjustment Auditor jobs in Michigan look for?

The top searched job categories for Senior Risk Adjustment Auditor jobs in Michigan are:

What cities in Michigan are hiring for Senior Risk Adjustment Auditor jobs?

Cities in Michigan with the most Senior Risk Adjustment Auditor job openings:

Infographic showing various Senior Risk Adjustment Auditor job openings in Michigan as of August 2026, with employment types broken down into 100% Full Time. Highlights an 69% In-person, 8% Hybrid, and 23% Remote job distribution.

Full-time

Posted 3 days ago

New


Blue Cross Blue Shield of Michigan rating

7.8

Company rating: 7.8 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

193rd of 308 rated insurance


Job description

Responsible for serving as an internal control consultant conducting internal corporate and information technology (IT) and system audits and reviews of business processes and supporting vendors. Provides risk education and project risk assessment to mitigate risk and assess the control environment of each auditable unit. Develops and communicates risks and recommended controls for multiple layers of leadership.

  • Conduct internal audits and reviews to identify risks, document established controls to mitigate risk and assess the control environment of each auditable unit.
  • Identify datasets/sources that are relevant to the audit and connect risks to data.
  • Communicate issues, audit results, and recommendations in a clear and concise manner to appropriate levels of operating and/or Information Technology management, including activity updates to the Audit Committee of the Board of Directors.
  • Assist in the development of the annual audit plan through risk universe identification.
  • Assist in the facilitation of project risk assessments and lessons learned sessions. Assist in conducting management action planning workshops to discuss business and IT risks, prioritize control issues and develop corrective action plans.
  • Provide information on business risk management standards and responsibilities and the implementation and application of a project risk control process.
  • Develop, maintain, and report against a work plan, as work progresses, given scope and objectives. Prepare complete and accurate audit workpapers in a timely manner.
  • Suggests improvements to audit methodologies, policies, and procedures to incorporate lessons learned, including innovative uses of data including analytics and visualization.
  • Assist in educating and training BCBSM project staff, employees and management on internal corporate and Information Technology controls and encourage change that promotes an effective and efficient control environment.

QUALIFICATIONS

  • Bachelor's Degree in Business Administration, Accounting, Finance, Management or Accounting Information Systems, Computer Science, or closely related field is required.
  • Four (4) years of related work experience, which includes two (2) years of identifying and evaluating technology risk and controls
  • One or more of the following professional certifications preferred: Certified Internal Auditor, Certified Public Accountant, Certified Information Systems Auditor, Certified in Risk and Information Systems Control, Certified Information Systems Security Professional, Certified in the Governance of Enterprise IT or Project Management Professional.
  • Strong analytical and critical thinking skills, as is necessary to identify datasets/sources that are relevant to the audit. 
  • Strong oral communication skills, including presentations, as is necessary to effectively communicate audit information to financial and non-financial individuals, including senior level management. 
  • Strong written communication skills, including the proven ability to tell a relevant business story using data and visualizations.
  • Intermediate problem-solving ability, as necessary to solve problems in a dynamic team environment and handle multiple assignments in a timely manner. 
  • Advanced conflict management skills, as necessary to resolve issues where corporate areas are in disagreement.
  • Intermediate proficiency using Microsoft Word, Excel, and Project.
  • Intermediate proficiency in use of audit software and visualization tools (i.e., automated work papers, ACL, Tableau, etc.).
  • Strong interpersonal skills to effectively interface with various levels of management as well as contacts outside the organization. 
  • Knowledge of project audit methodologies, risk management and project management techniques to detect and resolve complex multidisciplinary issues.
  • Demonstrate high standards of conduct and ethics as well as appropriate judgment, independence and discretion as required by the IIA Standard of Professional Practice of Internal Auditing and Code of Ethics.
  • Understanding of auditing principles and applications as derived from standards for the professional practice of internal and information technology auditing (i.e. Institute of Internal Auditors (COSO), the Information Systems 
  • Audit & Control Association (COBIT), and the Project Management Institute). 
  • Comprehensive understanding of auditing principles, processes, and working knowledge of information technology general controls (e.g. system development life cycle, change control, access administration) and business process - IT controls (e.g. application controls including embedded and configurable (i.e., passwords and edit checks, etc.).

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