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Senior Risk Adjustment Auditor Jobs (NOW HIRING)

Aquity Solutions

Director Risk Adjustment - Remote

$130K - $150K/yr

Director of Risk Adjustment About IKS Health For more information, visit: www.ikshealth.com IKS ... Directly manage a department of 70+ production coders and auditors. Lead the organizational design ...

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 ...

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

As of Jul 22, 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:
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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 100% Full Time. Highlights an 69% In-person, 8% Hybrid, and 23% Remote job distribution, with an average salary of $90,973 per year, or $43.7 per hour.
Auditor, Risk Adjustment (Remote)

Auditor, Risk Adjustment (Remote)

Molina Healthcare

Long Beach, CA • Remote

Full-time

Posted 5 days ago

Job description

JOB DESCRIPTION Job Summary

Provides audit support for Molina enterprise risk adjustment activities.  Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk, and estimates the potential financial consequences of an occurring loss.  Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.

Essential Job Duties

Facilitates daily operations of all aspects of risk adjustment data validation and audit-related activities, including but not limited to:  progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines.
Represents as a risk adjustment audit liaison with functional departments, health plans, and external vendors.
Evaluates results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans (CAPs) as necessary.
Oversees Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data transmissions, and assists in identification of issues that impact data integrity and accuracy.
Develops and implements processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data.
Identifies opportunities for data mining to ensure data gaps are minimized.
Applies best practices to ensure accuracy of risk adjustment payment in all markets.
Supports all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met.
Performs monthly audits on internal Molina coding specialist performance..
Facilitates audits on external Molina vendor performance.
 

Required Qualifications

At least 5 years of coding, medical record chart review, and risk adjustment data validation experience, or equivalent combination of relevant education and experience.
Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS), Certified Coding Specialist -Physician-based (CCS-P), or Certified Professional Coder (CPC).
Excellent attention to detail, documentation and organizational skills.
Critical-thinking, problem-solving and analytical skills.
Ability to work independently in a fast-paced, deadline-driven environment.
Ability to work cross-collaboratively in a highly matrixed environment, including ability to communicate audit findings with internal teams.  
Strong verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Microsoft Excel experience at intermediate or better.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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