[Hiring] Risk Adjustment Compliance Auditor @Alignment Health

Role Description

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.
• Support RADV and other risk adjustment audit initiatives.

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.
• Corrective action follow-through across the organization.

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.

Schedule:

• Full-time, Monday – Friday
• Initial training schedule will align primarily with Pacific Time business hours
• Flexible working hours available post-training based on business needs and team collaboration

Qualifications

• Minimum 3 years of professional coding experience in a medical group or health plan setting.
• Bachelor’s degree in business administration, health care management or in a related field or 4 years additional experience in lieu of education.
• Certified Coder required - CPC, CCS & CCS-P.

Requirements

• Experience with strategic planning in risk mitigation.
• Previous use of Epic, Allscripts, EZCap a plus.
• Proficient user in MS office suite, MS access a plus.
• Ability to communicate positively, professionally and effectively with others.
• Effective written and oral communication skills.
• Ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Benefits

• Pay Range: $64,384.00 - $96,577.00.
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.