Associate, Risk Adjustment Auditor (Healthcare)

Location: Remote for candidates residing in Arizona, Florida, Georgia, or Texas; occasional travel may be required for team meetings and company events.

Salary: $82,717–$108,566 per year, plus annual performance bonuses and employee benefits.

Company

hirify.global is a health insurance company built around a full-stack technology platform and focused on improving the member healthcare experience.

What you will do

• Conduct internal and external quality audits of ICD-10-CM diagnosis coding, medical records, and clinical documentation.
• Review medical records for ACA and Medicare Advantage risk adjustment activities, including potential CMS and HHS audits.
• Validate that EDGE data is supported by provider encounter documentation.
• Analyze Risk Adjustment Coding team performance and report audit trends to leadership.
• Conduct CMS Risk Adjustment Data Validation audits and maintain compliance with coding standards.
• Create provider education resources and implement process improvements that support risk adjustment factor increases.

Requirements

• Bachelor's degree in a relevant field or equivalent work experience.
• Certified Professional Coder (CPC) certification.
• 3+ years of retrospective risk adjustment coding experience.
• 1+ year of quality auditing and/or Risk Adjustment Data Validation Audit experience.
• Residence in Arizona, Florida, Georgia, or Texas is required for this remote role.

Nice to have

• Certified Risk Adjustment Coder (CRC) or similar certification.
• Experience coding in multiple Electronic Medical Record systems.

Culture & Benefits

• Remote work from an eligible U.S. state with occasional travel for team meetings and company events.
• Unlimited vacation program, paid sick time, paid holidays, and paid parental leave.
• Medical, dental, vision, life, and disability insurance.
• 401(k) plan participation, paid wellness time, and reimbursements.
• Annual performance bonuses and an inclusive equal opportunity workplace.