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Risk Adjustment - Risk Adjustment Coding Auditor 135-2014

CommunityCare • Tulsa, OK, US • published 2026-09-26 15:51:07.604545

Description

**JOB SUMMARY:** The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD\-10\-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity. **KEY RESPONSIBILITIES:** * Perform bi\-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements. * Ensure documentation supports coded conditions in accordance with ICD\-10\-CM, CMS, and payer\-specific guidelines. * Identify unsupported diagnoses, over coding, under\-coding, and documentation gaps. * Provide detailed audit findings and recommendations to coding teams, providers, and leadership. * Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards. * Track and report audit results, trends, and performance metrics. * Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy. * Assis...

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