Risk Adjustment Compliance Auditor (Remote)

<p style="text-align:left"><span>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.</span><span> </span><span>We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.</span></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p>Alignment Health is seeking a remote Risk Adjustment Compliance Auditor to support auditing and compliance activities related to risk adjustment data submitted to CMS. In this role, you will conduct provider and coder-level audits, review medical record documentation and coding accuracy, identify compliance risks and outliers, and support RADV and other risk adjustment audit initiatives.<br><br>This position is ideal for an experienced certified coder with a strong understanding of risk adjustment, HCC coding, compliance auditing, and CMS guidelines within a health plan, IPA, or managed care environment. You will partner closely with Risk Adjustment leadership and cross-functional teams to help ensure coding accuracy, regulatory compliance, audit readiness, and corrective action follow-through across the organization.<br><br>The role combines auditing, documentation review, reporting, compliance monitoring, and collaborative problem-solving in a fully remote environment. You will also help provide audit feedback and compliance education to internal and provider-facing stakeholders as needed.<br><br>Schedule:<br>- Full-time, Monday – Friday<br>- Initial training schedule will align primarily with Pacific Time business hours<br>- Flexible working hours available post-training based on business needs and team collaboration<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p>Job <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">Duties/Responsibilities:</span><br>1.    Monitors coding prevalence reporting, internal reporting trends, and coding outliers to support compliance and audit readiness.<br>2.    Reviews IPA Policies and procedures to ensure programs are compliant. <br>3.    Monitors internal coding staff accuracy percentages to ensure they are tracked and maintained. <br>4.    Monitors coding vendor’s accuracy percentages to ensure the coding accuracy and quality of the data submitted to CMS.<br>5.   Works with Risk Adjustment Management on data validation and RADV coding audit activities, including review of audit outcomes, findings, completeness, and coding accuracy of submissions to CMS.<br>6.    Maintains and develops audit tracking, reporting, and management tools related to Risk Adjustment Compliance activities.<br>7.    Ensures compliance with all applicable federal, state & and local regulations, as well as <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">institutional/organizational</span> standards, practices, policies & procedures.<br>8.    Works with Risk Adjustment Management to monitor HCC corrective action plans and follow-up activities related to audit and review findings.<br>9.    Suggests customizations of Risk Adjustment education for support staff, PCPs, specialists, employees, contracted employees and central departments.<br>10.    Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. <br>11.    Maintains current knowledge of CMS audit processes, risk adjustment regulations, and industry best practices through ongoing education, professional development, and participation in relevant professional organizations.<br>12.    Contributes to team effort by accomplishing related results as needed. <br>13.    Represents and actively participates in RADV and other risk adjustment-related audits and compliance activities.<br>14.    Other duties as assigned to meet the organization’s needs.</p><p></p><p><b><u>Job Requirements:</u></b></p><p><b><u>Experience:</u></b></p><p>• Required: Minimum 3 years of professional coding experience in a medical group or health plan setting.</p><p>• Preferred: None.</p><p><b><u>Education:</u></b></p><p>• Required: Bachelor’s degree in business administration, health care management or in a related field or 4 years additional experience in lieu of education.</p><p>• Preferred: None.</p><p><b><u>Training:</u></b></p><p>• Required: Certified Coder required - CPC, CCS & CCS-P.</p><p>• Preferred: Certified Auditor.</p><p><b><u>Specialized Skills:</u></b></p><p>• Required:</p><ul><li>Experience with strategic planning in risk mitigation.</li><li>Previous use of Epic, Allscripts, EZCap a plus.</li><li>Proficient user in MS office suite, MS access a plus.</li><li>Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>Report Analysis Skills:  Comprehend and analyze statistical reports.</li></ul><p><b><u>Licensure:</u></b></p><p>• Required: Certified Coder required - CPC, CCS & CCS-P.</p><p>• Preferred: None.</p><p><u>Essential Physical Functions:</u></p><p>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><p></p><p>1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.</p><p>2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.</p>Pay Range: $64,384.00 - $96,577.00<p>Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. <b> </b></p><p></p><p>Alignment Health is an Equal <span><span><span><span><span><span><span><span><span><span><span><span><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">Opportunity/Affirmative</span></span></span></span></span></span></span></span></span></span></span></span></span> Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.</p><p></p><p><i><span><span><span><span><span><span><span><span><span><span><span><span><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">*DISCLAIMER: Please</span></span></span></span></span></span></span></span></span></span></span></span></span> beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal <span><span><span><span><span><span><span><span><span><span><span><span><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">information. Please</span></span></span></span></span></span></span></span></span></span></span></span></span> be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at <a href="https://protect-us.mimecast.com/s/P1GaC82l6KF8ygOUngCFQ/" target="_blank" rel="noopener noreferrer"><span><span><span><span><span><span><span><span><span><span><span><span><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">https://reportfraud.ftc.gov/#/</span></span></span></span></span></span></span></span></span></span></span></span></span></a>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email <a href="mailto:careers@ahcusa.com" target="_blank" rel="noopener noreferrer">careers@ahcusa.com</a>.</i></p>

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...