Risk Adjustment Auditor I or II

Risk Adjustment Auditor I or II Cambia Health Solutions -

Newcastle, WA Posted:

3/23/2026 -

Expires:

6/22/2026

Job ID:

293301283 Job Description Risk Adjustment Auditor I or II Work a Hybrid schedule within Oregon, Idaho, Utah or Washington Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Risk Adjustment Auditors is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Auditors perform Retrospective/Prospective chart reviews both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting. They also Identify trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies - all in service of making our members' health journeys easier. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to

Cambia:

Qualifications:

Risk Adjustment Auditor I would have an Associate degree in Healthcare or related field and one year of experience in clinical coding or auditing or equivalent combination of education and experience. Risk Adjustment, HCC or Inpatient coding experience required. Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required. RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.

Skills and Attributes:

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
• Knowledge of and adherence to Official

ICD-9-CM/ICD-10

Coding Guidelines.

• Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
• Demonstrated ability to identify and communicate trends in provider coding and documentation.
• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
• Effective verbal and written communication skills.

Additional for

Risk Adjustment Auditor II:

• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
• Demonstrated ability to provide proactive and creative solutions to business problems.

What You Will Do at

Cambia:

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
• Supports and actively participates in process and quality improvement initiatives.
• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
• Consistently meets departmental performance and attendance requirements.

Additional for

Risk Adjustment Auditor II:

• Serves as a mentor to Risk Adjustment Auditor I staff.
• Assists with special projects such as risk mitigation reviews.
• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
• Monitors and interprets regulatory changes that may imp To view the full job description, https://www.

aplitrak.com/?adid=YmJnZW5lcmljLjU1NjE2Ljg3NjlAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20">click here Job Summary Veteran Preference Company Details Company Cambia Health Solutions Industry Fitness and Recreational Sports Centers Job Information Location Newcastle, WA Job Type Full Time Employee Job Position 1 Position(s) Open Duration Over 150 Days Additional Information Reference Code R-6199_3-4181 Federal Contractor No Affirmative Action Plan No