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Risk Adjustment Auditor Job in Bronx, New York

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Job Title: Risk Adjustment Auditor

Employer:CenterLight Health System
Skills:HCC coding
Preferred Certifications:Certified Risk Adjustment Coder (CRC),Certified Professional Coder (CPC)
Required Experience:3 to 4 years
Location:1733 Eastchester Road Bronx 10461, NY, US
Date Posted:1/15/2021


Responsible for auditing, evaluating and consistently improving the risk adjustment processes for CenterLight Health System. Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality care. Serve as a subject matter expert contact within Center Light Healthcare Departments regarding Coding questions. Train Medical Practice Assistants, Physicians and IDT disciplines in ICD-9 / ICD-10 guidelines.



  • Audit coding processes to ensure accurate diagnoses data has been submitted to Claims, and CMS.
  • Subject matter expert on risk adjustment coding processes and CMS data validation
  • Review and analyze monthly financial reports submitted by Medicare related to diagnostic data.
  • Work in conjunction with other departments (Finance, Provider Relations, Quality, Medical Directors) to ensure compliance of CMS risk adjustment guidelines are met.
  • Conduct provider and employees training regarding risk adjustment to ensure accurate CMS payment and to improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, emails etc.
  • Serves as a subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare.
  • Review coding and billing process for operational enhancements. Responsible for reviewing and implementing accurate Medical / Coding policies and Claims Manager edits across all PACE sites.
  • Researches and prepares changes and additions to procedure master, fee schedules, diagnosis tables and modifier tables to ensure proper reporting of procedures.
  • Responsible for the overall supervision of the “super bill” process manage by the Medical Practice staff.
  • Monitor closely accuracy and timely submission of clinical documentation in Medical Records and/or Electronic medical record solution. Perform monthly audits to clinical staff documentation.
  • Train and coach physicians and IDT staff disciplines regarding Coding documentation policies.
  • Performs retrospective chart audits for proper documentation and assure accuracy of diagnostic coding medical documentation.
  • Perform random audits to coding submissions by outside vendors.
  • Other duties as assigned.


Education:  High School Diploma, College degree preferred.

Must have at least one of the following Certifications with an active status by the American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA): Certified Professional Coder (CPC), by AAPC Certified Risk Adjustment Coder (CRC), by AAPC Certified Coding Specialist (CCS), by AHIMA

Experience: At least five (5) years prior experience in Coding related field.

Other: Bilingual preferably, Typing and Computer skills. Available to consistently travel around all PACE Sites on a regular basis.


If you are interested, please email a resume to Ashley Chau at achau@centerlight.org

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