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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 ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Leads end-to-end program management for chart review initiatives, in-home assessments (IHA ... Owns and governs the end-to-end data flow from coding vendor output through internal quality ...

Humana

Medical Coder Educator

Alexandria, VA · On-site +1

$20 - $26.75/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Holly Springs, NC · On-site +1

$16.25 - $21.75/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Morrisville, NC · On-site +1

$17.50 - $23.50/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Mount Crawford, VA · On-site +1

$17.75 - $23.75/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

$19.25 - $25.50/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Marion, NC · On-site +1

$17.50 - $23.25/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Jacksonville, NC · On-site +1

$17 - $22.50/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Beaufort, SC · On-site +1

$17 - $22.75/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Gaffney, SC · On-site +1

$17.25 - $23.25/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

Humana

Medical Coder Educator

Jonesville, VA · On-site +1

$19 - $25.25/hr

... or auditing in a healthcare setting experience * Proficiency with data analytics tools (such as ... Medicare Risk Adjustment knowledge Additional Information Work at home - with travel (up to 5%) to ...

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Work From Home Risk Adjustment Auditor information

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$30.5K

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

As of Jul 21, 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.

More about Work From Home Risk Adjustment Auditor jobs
What cities are hiring for Work From Home Risk Adjustment Auditor jobs? Cities with the most Work From Home Risk Adjustment Auditor job openings:
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Work From Home Risk Adjustment Auditor jobs near you
Infographic showing various Work From Home Risk Adjustment Auditor job openings in the United States as of July 2026, with employment types broken down into 75% Full Time, and 25% Contract. Highlights an 100% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Risk Adjustment Coding Specialist II - Orange County

Astrana Health, Inc.

Orange, CA • Remote

$70K - $85K/yr

Full-time

Posted 28 days ago

Job description

Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Orange County market.  In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. 
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! This position requires travel to provider offices up to 75% of the time OC.
Our Values: 
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification -  Certified Coding Specialist (CCS-P), CCS, or CPC.
  • At least 3 years of experience in risk adjustment coding and/or billing experience required
  • Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate 
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
You're great for this role if:    
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Environmental Job Requirements and Working Conditions
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires up to 75% travel to provider offices in Orange County. 
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.    

Additional Information:     
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.