Health Plan Auditor

Title:

Health Plan Coding Auditor – RADV (Remote, EST Hours) Type:

Contract Openings:

3 Schedule:

Monday–Friday,

7:00 AM–3:30 PM EST (non-negotiable) Location:

100% Remote (must work EST hours) Overview We are seeking experienced

Health Plan Coding Auditors

to support large-scale

RADV and Quality Health Plan (QHP)

audit initiatives. This role focuses on

ICD-10-CM code abstraction, coding validation, and risk adjustment accuracy

within a payer environment. This position requires strict adherence to scheduled work hours and

exclusive commitment

during the assignment (no secondary employment permitted). Key Responsibilities Perform

RADV/QHP code abstraction and coding quality audits

using ICD-10-CM. Review medical records to ensure diagnoses are

accurately captured and fully supported

by documentation. Code

government and state risk adjustment models , including full “code-everything” projects. Apply Official Coding Guidelines, AHA Coding Clinic guidance, CMS requirements, and state/federal regulations. Maintain

95% coding accuracy

across all assigned audits. Document findings clearly and follow internal audit workflows and policies. Required Qualifications 7+ years of coding experience , with

5+ years in Risk Adjustment (RADV required) . Active AHIMA or AAPC certification (CPC required; CRC strongly preferred). Experience auditing within a

health plan / payer environment . Strong ICD-10-CM knowledge for risk adjustment models. Proficiency with Microsoft Excel, Outlook, and Word. Ability to work independently in a secure, remote environment. Private, lockable home office to protect PHI. Must attest to

no other employment during assignment . EST hours required (7:00 AM start)

— engagement during core hours is mandatory.