Risk Adjustment Auditor II

Location: Hybrid role requiring three days per week in an office in Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, or Lewiston, United States. Candidates should live within commuting distance of the Salt Lake City, Boise, Fargo, or Lewiston offices or be willing to relocate. Local or out-of-state travel may be required.

Salary: $69,700–$94,300 expected annual hiring range for Oregon, Utah, and Idaho; full annual range $65,000–$107,000 with a 10% bonus target. North Dakota hourly range: $28.70–$45.93.

Company

hirify.global is a purpose-driven health care organization focused on making health care easier and supporting a person-focused, economically sustainable health care system.

What you will do

• Perform retrospective and prospective medical-record reviews to support accurate risk adjustment reporting.
• Audit vendor coding and verify the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes.
• Identify diagnosis codes supported by medical records under CMS HCC and HHS HCC categories.
• Identify provider and vendor coding and documentation trends and help develop intervention strategies.
• Support process and quality improvement initiatives while maintaining compliance with regulatory requirements.
• Mentor Risk Adjustment Auditor I staff, support risk mitigation projects, and interpret regulatory changes affecting the program.

Requirements

• Associate degree in health care or a related field, or an equivalent combination of education and experience.
• At least three years of clinical coding or auditing experience for Auditor II, including risk adjustment, HCC, or inpatient coding experience.
• CPC and CRC coding certifications are required.
• Advanced knowledge of risk adjustment, coding, documentation requirements, reimbursement methodologies, and coding conventions.
• Ability to perform accurate chart reviews and quality audits, identify problems, develop solutions, and communicate coding trends.
• Proficiency with PC software such as Word, Excel, and Outlook, together with effective verbal and written communication skills.

Nice to have

• Experience with AI tools and technologies for productivity and professional decision-making.
• Knowledge of health systems operations and governmental and commercial health care products.

Culture & Benefits

• Purpose-driven, collaborative, and supportive work environment focused on sustainable, person-focused health care.
• Medical, dental, vision, and mental health coverage, plus annual employer contributions to a health savings account.
• Paid time off, 10 company-paid holidays, and up to 12 weeks of paid parental leave for eligible employees.
• 401(k) retirement plan with a significant company match and potential discretionary contribution.
• Wellness programs, employee assistance support, commute and parking benefits, and employee resource groups.
• Work-from-home options may be available with a wired internet connection meeting the stated speed requirements; MFA setup requires a personal mobile device.

Hiring process

• A background check is required.
• Reasonable accommodations are available during the application process.