Senior Risk Adjustment Coding Auditor

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health 

aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help 

them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com. 

SUMMARY DESCRIPTION

The Senior Risk Adjustment Coding Auditor is a highly experienced coding professional responsible for ensuring compliant, accurate, and high-quality risk adjustment coding across Medicare Advantage programs. This role is critical to organizational success in CMS Risk Adjustment Data Validation (RADV) audits, broader CMS compliance audit activities, and vendor quality oversight initiatives. The ideal candidate is a self-directed professional with strong project management skills, deep Medicare Advantage expertise, and a passion for coding excellence, regulatory compliance, and continuous improvement. 

ESSENTIAL FUNCTIONS:

• Review, validate, and code Medicare Advantage medical records using ICD-10-CM and CMS-HCC methodologies to support accurate and compliant risk adjustment submissions. 
• Conduct quality assurance audits to ensure coding accuracy, documentation integrity, HCC capture, and compliance across vendors, in-home assessment programs, and other risk adjustment initiatives. 
• Serve as a key resource for RADV audits and other regulatory reviews, including chart review, documentation validation, audit preparation, audit response support, and audit readiness activities. 
• Monitor coding quality and vendor performance to identify trends, risks, gaps, and opportunities for improvement. 
• Partner with vendors and cross-functional teams to lead quality improvement initiatives, resolve audit findings, implement corrective actions, and provide actionable recommendations to leadership and key stakeholders. 
• Provide subject matter expertise related to ICD-10-CM, CMS-HCC methodology, Medicare Advantage regulations, RADV requirements, and evolving CMS guidance. 
• Leverage technology, analytics, and digital tools to improve coding accuracy, operational efficiency, productivity, and audit effectiveness. 

Requirements

Qualifications Requirements and Preferences

Required:

• Active coding certification required; CRC strongly preferred. Acceptable credentials include CRC, CPC, CCS, RHIT, RHIA, or other equivalent coding certifications. 
• Minimum of 5 years of Medicare Advantage Risk Adjustment coding and auditing experience. 
• Advanced knowledge of CMS-HCC risk adjustment methodology, ICD-10-CM coding guidelines, Medicare Advantage regulations, RADV requirements, and diagnosis validation standards. 
• Experience auditing coding vendors, in-home assessment programs, and risk adjustment submissions, including quality assurance and coding validation reviews. 
• Strong analytical, problem-solving, organizational, and communication skills. 
• Proficiency with Microsoft Excel, coding platforms, and audit reporting tools. 
• Proven ability to work independently, manage multiple priorities, adapt to changing business needs, and deliver high-quality results in a fast-paced, evolving environment. 
• Demonstrate commitment to coding accuracy, compliance, and continuous quality improvement. 

Preferred:

• Bachelor's degree in Health Information Management, Nursing, or a related healthcare 
• field. 
• Experience supporting health plan risk adjustment operations. 
• Experience developing coding guidelines, audit methodologies, or coding education 
• materials. 
• Experience in a startup, growth-stage, or highly matrixed healthcare environment. 
• Experience utilizing technology and analytics to improve operational performance and coding outcomes.

Member-centric Impact Statement:

At Zing Health, accurate and compliant risk adjustment coding is about more than data—it helps ensure our members' health conditions are fully represented, enabling appropriate care coordination, resource allocation, and health outcomes. This role directly contributes to our mission of delivering high-quality, member-centered care by maintaining coding integrity, supporting regulatory compliance, and promoting coding excellence across the organization. 

Zing Health offers the following benefits:

•  A competitive salary based on the market 
•  Medical, Dental, and Vision 
•  Employer-Paid Life Insurance 
•  Paid Maternal Leave 
•  Paid Paternal Leave 
•  401(K) match up to 4% 
•  Paid-Time-Off 
•  Employee Assistance Programs 
•  Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc. 

Zing Health is committed to being an Equal Opportunity Employer. This means the company ensures all employment decisions, including hiring, promotion, compensation, and benefits, are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. Zing Health strives to create a diverse, inclusive, and respectful workplace, 

providing equal access and opportunities for all employees and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member.