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Work From Home Risk Adjustment Auditor Jobs (NOW HIRING)

HealthEdge

Director, Risk Adjustment Products

The Director will work closely with technical and operations teams, both internally and externally ... Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS ...

Boston Medical Center

Risk Adjustment Coder

$19.25 - $25.50/hr

Coding Certification from American Academy of Professional Coders (AAPC) or American Health ... Willing to work as a team - innovation and collaboration is a priority * Experience with an ...

Medica

Senior Director Risk Adjustment

We're a team that owns our work with accountability, makes data-driven decisions, embraces ... Provide integrated leadership across HEDIS and Risk Adjustment to ensure the full lifecycle-from ...

Privia Health

National Director, Risk Adjustment

$130K - $160K/yr

The National Director, Risk Adjustment identifies and implements initiatives to achieve complete ... Employees who regularly work from home offices are eligible for expense reimbursement to offset ...

Privia Health

National Director, Risk Adjustment

$130K - $160K/yr

The National Director, Risk Adjustment identifies and implements initiatives to achieve complete ... Employees who regularly work from home offices are eligible for expense reimbursement to offset ...

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Work From Home Risk Adjustment Auditor information

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How much do work from home risk adjustment auditor jobs pay per year?

As of Jun 10, 2026, the average yearly pay for work from home risk adjustment auditor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Work From Home Risk Adjustment Auditor position, and why are they important?

To thrive as a Work From Home Risk Adjustment Auditor, you need a strong understanding of medical coding (especially ICD-10-CM), healthcare compliance, and medical record review, often supported by credentials such as CPC or CRC certification. Familiarity with electronic medical records (EMR) systems, health plan software, and auditing platforms is essential. Excellent attention to detail, organizational skills, and the ability to work independently make candidates stand out in this remote position. These skills ensure accurate risk adjustment data, regulatory compliance, and reliable performance while collaborating virtually with healthcare teams.

What is a Work From Home Risk Adjustment Auditor job?

A Work From Home Risk Adjustment Auditor is responsible for reviewing medical records to ensure accurate coding and documentation for risk adjustment purposes. They assess diagnoses, procedures, and services to verify that they align with coding guidelines and regulatory requirements. This role helps healthcare organizations optimize reimbursement and maintain compliance with coding standards. Working remotely, auditors use electronic health records and coding software to perform their duties efficiently. Strong attention to detail, coding certification (such as CRC, CPC, or CCS), and knowledge of risk adjustment models are essential for success in this role.

What are the typical daily responsibilities of a Work From Home Risk Adjustment Auditor?

As a Work From Home Risk Adjustment Auditor, your typical day involves reviewing medical records to identify and validate diagnosis codes, ensuring compliance with Medicare, Medicaid, or commercial risk adjustment guidelines. You will often manage a queue of charts, utilize specialized auditing software, and document your findings clearly for reporting purposes. Communication with team members or supervisors is usually conducted via phone, email, or secure messaging platforms. This role may also require you to participate in quality assurance reviews, training sessions, and periodic team meetings to stay updated on coding standards and audit protocols.

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Work From Home Risk Adjustment Auditor jobs near you
HEALTH CODER - HCC & RISK ADJUSTMENT

HEALTH CODER - HCC & RISK ADJUSTMENT

NORTH EAST MEDICAL SERVICES

Burlingame, CA • Remote

$42.79 - $48.75/hr

Other

Posted 24 days ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor
  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required. 
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position. 

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