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Work From Home Risk Adjustment Auditor Jobs (NOW HIRING)

Greater Good Health

Risk Adjustment Coding Specialist

$80K - $95K/yr

This role will work closely with leaders across Revenue Cycle, Clinical Operations amp; Clinical ... from working for a set period of time. * Collaborative and Supportive Community: Join our ...

Virtix Health LLC

HCC Coding Quality Specialist

All HCC/Risk Adjustment auditors MUST be certified through either the AAPC or AHIMA ... Remote Work from home (within the U.S. ONLY). You need a HIPAA compliant home office, high-speed ...

Bannerhealth

Risk Adjustment Coding Reviewer

Risk Adjustment Work Shift: Day Job Category: Risk, Quality and Safety A rewarding career that fits ... The posted compensation range is a reasonable estimate that extends from the lowest to the highest ...

New

Urrly

Telehealth Nurse Practitioner

Des Moines, IA · On-site +1

$600 - $720/day

HCC risk adjustment documentation experience Perks & pay * Pay: $600-$720 daily earning potential * 1099 contractor flexibility * Fully remote work from home * Consistent visit flow and structured ...

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Quality Assurance Coder & Auditor - HCC Coding

OR · Remote

$48.49/hr

Review and validate HCC coding and risk adjustment documentation . * Identify missed, unsupported ... Ability to work independently and effectively in a remote environment. Preferred Experience

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

As of Sep 3, 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 is a work from home risk adjustment auditor?

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.

What are the key skills and qualifications needed to thrive in the work from home risk adjustment auditor position?

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 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 August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Risk Adjustment Documentation & Coding Educator (CRC Required)

Privia Health

Remote

$70K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

Privia Health rating

6.7

Company rating: 6.7 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

Job description

Company Description
Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Job Description
Travel: ~4 Trips a year for Summits/Educations
The Risk Adjustment Documentation & Coding Educator is responsible for supporting the growth and improvement of Privia Health's risk adjustment capabilities by conducting training, education, and management of coding and documentation improvement programs. The Educator will enhance the educational programs necessary to support value-based care initiatives impacting the Medicare Shared Savings Program and Medicare Advantage and Commercial value-based care agreements. This individual will work in a matrixed organization to deliver complex ideas, support various key stakeholders, and assist with executing new risk adjustment initiatives. The ideal candidate is knowledgeable in coding and documentation guidelines, knows how to develop strong relationships with clinicians, and is an effective, strong communicator. Successful candidates will also have extensive presentation experience in the following areas: ICD-10-CM, CPT and HCPCS.
  • Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually
  • Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
  • Analyze key coding performance indicators and audit error rates to target high-risk clinical areas or providers requiring intensive data validation.Conduct comprehensive prospective and retrospective medical record chart audits to validate the accuracy of ICD-10-CM coding and HCC assignments.
  • Ensure all audited charts meet CMS documentation requirements (e.g., MEAT criteria: Monitor, Evaluate, Assess, Treat) and ensuring data integrity, regulatory compliance, and optimal risk score accuracy through rigorous medical record auditing
  • Utilize a compliant provider query process to clarify conflicting, ambiguous, or incomplete documentation identified during the chart review process.
  • Generate detailed audit findings, error reports, and accuracy scores to identify trends in under-coding, over-coding, and documentation vulnerabilities.
  • Analyze claims data and electronic health records to identify suspected gaps in care and recapture opportunities for chronic conditions.
  • Identify training priorities and proactively schedule provider trainings with provider's offices, individual providers and groups of providers
  • Train on effective EHR workflows to support coding and documentation for both known and suspected conditions.
  • Expert in how providers document and code in the EHR clinical record
  • Meet key performance indicators and quarterly objectives
  • Act as the internal subject matter expert and escalation point for risk adjustment, and coding documentation
  • Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
  • Perform other related duties, which may be inclusive, but not listed in the job description

Qualifications
  • 5+ years' experience with coding and documentation
  • Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) Required
  • Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
  • Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
  • MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, G-Suite, other software programs and internet based applications as needed to fulfill position duties
  • A valid unrestricted drivers' license and a reliable vehicle
  • Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations

The salary range for this role is $70,000 to $85,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Technical Requirements (for remote workers only, not applicable for onsite/in office work):
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

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