Risk Adjustment Coding Auditor

Job Listing ID:

4484596

Job Title:

Risk Adjustment Coding Auditor Application Deadline:

05/31/2026

Job Location:

Springfield

Date Posted:

05/01/2026

Hours Worked Per Week:

40

Shift:

Day Shift Duration of Job:

Full Time, more than 6 months You may contact this employer directly. (Obtain the contact information to print or add to your jobs.)

Job Summary:

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Risk Adjustment Coding Auditor reviews medical records to ensure accurate, compliant

ICD 10 CM

coding across Medicare Advantage, ACA/Commercial, and Medicaid programs. This role validates coding accuracy and specificity, audits external coding vendors, and provides feedback to improve documentation and coding performance. The auditor also leads ACA and Medicare Advantage RADV activities, ensuring timely retrieval, review, and submission of records in line with federal and state requirements.

Essential Responsibilities:

• Conduct retrospective and prospective medical record audits to ensure

ICD 10 CM

diagnosis codes are accurate, complete, specific, and supported by documentation.

• Ensure all coding practices comply with CMS risk adjustment guidelines, ICD 10 CM Official Coding Guidelines, and

AAPC/AHIMA

standards.

• Identify coding trends, documentation gaps, errors, and opportunities to improve risk score accuracy.
• Validate clinical evidence supporting chronic condition coding to ensure proper documentation and submission.
• Prepare detailed audit reports summarizing findings, error categories, trends, and recommendations for corrective action.
• Provide clear, constructive feedback to coding teams, providers, and vendor partners based on audit outcomes.
• Develop and deliver training materials, job aids, and educational sessions to address documentation and coding improvement areas.
• Serve as a subject matter expert on risk adjustment coding best practices, documentation requirements, and regulatory updates.
• Collaborate with internal teams including Risk Adjustment Operations, Coding, Compliance, Quality, and Provider Engagement.
• Lead and execute ACA and Medicare Advantage RADV audits, including medical record retrieval, coding review, appeals support, and documentation submission to IVA and CMS portals.
• Oversee coding vendors and In Home Assessment programs to ensure performance aligns wi To view the full job description please use the link below.

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Job Classification:

Medical Records Specialists Access our statewide or regional occupation report for more information about wages, employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Depending on Experience Job Requirements

Experience Required:

 At least 1 year

Education Required:

None

Minimum Age:

N/A Gender:

N/A