Sr. Risk Adjustment Auditor
Remote
USD 36.83-42.74 / hour
Who You Are
You’re a collaborative professional, driven by the potential to make a meaningful impact in healthcare. The challenges of healthcare don’t deter you—instead, you see them as opportunities to find innovative solutions that benefit the partners, people, and communities we serve. Honest Health’s commitment to purpose, innovation, communities, and kindness resonates with you, inspiring you to bring commitment, creativity, and compassion into your work. You’re ready to join a team focused on reimagining primary care for a healthier future that benefits all.
Does this sound like you? Let’s 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 stakeholders—from 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, we’re creating a value-driven model that creates lasting benefits for everyone, now and into the future.
For us, that’s just an Honest day’s 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.
Associate’s or Bachelor’s 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 $36.83 - $42.74. Compensation takes into account several factors including but not limited to a candidate’s 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.