Auditor, Risk Adjustment (Remote)
Posted 2025-08-23
Remote, USA
Full Time
Immediate Start
<strong>Job Description</strong>
<br><strong>Job Summary</strong>
<br>
Develops, recommends and implements controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.
<br>
<strong>Knowledge/Skills/Abilities</strong>
<br>
• Assist in the daily operations of all aspects of risk adjustment data validation related activities, including, but not limited to: progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines
<br>
• Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met
<br>
• Evaluate results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans as necessary
<br>
• Acts as an audit liaison with other departments, health plans, and external vendors
<br>
• Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data
<br>
• Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy
<br>
• Identify opportunities for data mining to ensure data gaps are minimized
<br>
• Apply best practices to ensure accuracy of risk adjustment payment in all markets
<br>
• Performs monthly audit on internal Molina Coding Specialists
<br>
• Audits external Molina Vendors.
<br>
<strong>Job Qualifications</strong>
<br>
<br><strong>Required Education</strong>
<br>
Associates degree.
<br><strong>Required Experience</strong>
<br>
3 Years in coding and medical record chart review and experience with risk adjustment data validation
<br>
Required Li
<br><strong>Required License, Certification, Association</strong>
<br>
Active and unrestricted Coding Certification, Active CCS, CCS-P, or CPC credential
<br><strong>Preferred Education</strong>
<br>
Bachelor's Degree in Business Administration, Health Care Management o
<br>
<br>
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
<br>
<br>
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
<br><strong>Job Summary</strong>
<br>
Develops, recommends and implements controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.
<br>
<strong>Knowledge/Skills/Abilities</strong>
<br>
• Assist in the daily operations of all aspects of risk adjustment data validation related activities, including, but not limited to: progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines
<br>
• Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met
<br>
• Evaluate results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans as necessary
<br>
• Acts as an audit liaison with other departments, health plans, and external vendors
<br>
• Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data
<br>
• Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy
<br>
• Identify opportunities for data mining to ensure data gaps are minimized
<br>
• Apply best practices to ensure accuracy of risk adjustment payment in all markets
<br>
• Performs monthly audit on internal Molina Coding Specialists
<br>
• Audits external Molina Vendors.
<br>
<strong>Job Qualifications</strong>
<br>
<br><strong>Required Education</strong>
<br>
Associates degree.
<br><strong>Required Experience</strong>
<br>
3 Years in coding and medical record chart review and experience with risk adjustment data validation
<br>
Required Li
<br><strong>Required License, Certification, Association</strong>
<br>
Active and unrestricted Coding Certification, Active CCS, CCS-P, or CPC credential
<br><strong>Preferred Education</strong>
<br>
Bachelor's Degree in Business Administration, Health Care Management o
<br>
<br>
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
<br>
<br>
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.