Sr. Risk Adjustment Auditor

Who You Are

Youre a collaborative professional driven by the potential to make a meaningful impact in healthcare. The challenges of healthcare dont deter youinstead you see them as opportunities to find innovative solutions that benefit the partners people and communities we serve. Honest Healths commitment to purpose innovation communities and kindness resonates with you inspiring you to bring commitment creativity and compassion into your work. Youre ready to join a team focused on reimagining primary care for a healthier future that benefits all.

Does this sound like you Lets connect.

Who We Are

At Honest Health we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholdersfrom health systems physician organizations and payers to providers practices and patients to deliver innovative solutions that elevate care control costs and support long-term health. Guided by our core values were creating a value-driven model that creates lasting benefits for everyone now and into the future.

For us thats just an Honest days work.

Your Role

The Risk Adjustment Auditor is a key contributor within the Clinical Documentation Integrity (CDI) program responsible for ensuring the accuracy completeness and compliance of risk adjustment coding and documentation across both internal teams and third-party vendors.

This role operates across concurrent and retrospective review workflows auditing clinical documentation coded data and claims to verify adherence to ICD-10-CM guidelines CMS Medicare risk adjustment requirements MEAT criteria and HCC capture standards. The Auditor serves as a quality control function for both vendor-delivered and internally produced CDI work identifying gaps validating accuracy and driving continuous improvement.

In addition to audit responsibilities this role plays a critical part in translating findings into actionable insights supporting provider education influencing documentation practices and strengthening overall program performance.

Primary Functions of the Risk Adjustment Auditor Include:

• Audit third-party vendor coding and CDI outputs to ensure accuracy compliance and adherence to contracted performance standards

• Audit internal CDI Specialist I and II work including chart reviews queries and reconciliation activities

• Identify coding inaccuracies unsupported diagnoses missed HCC opportunities and documentation gaps

• Deliver audit findings trend analysis and corrective action recommendations to CDI leadership and vendor partners

• Track and report audit performance metrics to support continuous quality improvement initiatives.

• Review completed encounters in the post-visit pre-billing window to validate documentation completeness and coding accuracy

• Review and audit Pre-visit plan coding and CDI

• Evaluate alignment between medical record documentation and draft claims ensuring proper HCC capture

• Assess each diagnosis for appropriate ICD-10-CM specificity and MEAT criteria compliance

• Prioritize high-impact conditions and risk-adjustable diagnoses for intervention and resolution

• Ensure compliant query practices aligned with AHIMA and ACDIS standards

• Review query quality provider responses and documentation updates to confirm clinical support for diagnoses

• Validate final alignment between documentation and submitted claims resolving discrepancies in partnership with coding and billing teams

• Translate audit findings into targeted provider and team education on documentation coding specificity and risk adjustment compliance

• Partner with CDI coding and leadership teams to improve workflows policies and audit readiness

• Serve as a subject matter expert and resource on risk adjustment CDI best practices and audit standards

• Support the evolution of CDI and audit processes as automation EMR integrations and vendor models mature

• Identify opportunities to expand audit scope (e.g. documentation patterns provider performance trends process inefficiencies)

• Contribute to the development of scalable audit frameworks and quality assurance methodologies

• Deliver real-time and aggregate coding and documentation feedback to providers and their clinical support teams

• Design and facilitate education sessions on ICD-10-CM specificity chronic condition documentation HCC coding and risk adjustment compliance both virtually and on occasion in person

• Perform other related responsibilities as assigned

How You Qualify

You reviewed the Who You Are section of this job posting and immediately felt the need to read on. This makes you a match for our innovative culture. You accept things change quickly in a startup environment and are willing to pivot quickly on priorities.

• Associates or Bachelors degree in Health Information Management Nursing or a related clinical field (or equivalent experience)

• 5 years of experience in risk adjustment medical coding CDI or auditing

• 2 years of experience in prospective and concurrent review risk adjustment coding and auditing

• Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding required

• Experience auditing vendor-delivered work and/or CDI programs preferred

• One or more of the following certifications:

• CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) are required

• CCS (Certified Coding Specialist) or CCDS (Certified Clinical Documentation Specialist) is preferred

• RHIT/RHIA is preferred

• Advanced knowledge of ICD-10-CM Official Guidelines and AHA Coding Clinic guidance

• Advanced technical expertise in risk adjustment and coding compliance

• Strong understanding of CMS risk adjustment methodologies and HCC models

• Expertise in MEAT criteria application and compliant query practices

• Familiarity with CDI workflows EMR systems and coding/audit tools

• Strong analytical skills with the ability to identify patterns risks and improvement opportunities

• High attention to detail and commitment to accuracy and compliance

• Ability to collaborate effectively across CDI coding vendor management and provider teams

• Ability to translate complex audit findings into clear actionable insights

• Effective communication and collaboration skills across clinical and non-clinical stakeholders

• Ability to manage multiple priorities in a fast-paced evolving environment

• Ability to work independently in a remote environment

• Willingness to travel up to 25% for provider education or team collaboration

• Commitment to maintaining confidentiality and compliance with all regulatory requirements

The base pay range for this role is $76600.00 - $88899.00. Compensation takes into account several factors including but not limited to a candidates experience education skills licensure and certifications and organizational needs. Base pay is just one piece of the total rewards program offered by Honest. Eligible roles also qualify for short-term incentives and a comprehensive benefits package.