Risk Adjustment Audit Reviewer

Job Description
Risk Adjustment Audit Reviewer
Client: Banner Health
Location: 2901 N. Central Avenue, Phoenix, AZ 85012
Openings: 1
Start Date: October 5, 2026
End Date: October 2, 2027
Assignment Length: Approximately 12 months
Work Arrangement: To be confirmed
Pay Rate: To be confirmed
Position Summary
Banner Health is seeking a Risk Adjustment Audit Reviewer to serve as a coding compliance resource. This individual will review audit findings, identify coding and compliance opportunities, provide education, and supply objective documentation supporting audit conclusions.
Supporting documentation may include current coding conventions, CMS and regulatory requirements, risk-adjustment guidelines, and Banner Health policies.
Key Responsibilities

• Audit vendor risk-adjustment coding activity.
• Review audit findings for coding accuracy and compliance.
• Provide education to internal staff based on audit results.
• Clearly communicate audit processes, findings, and recommendations to leaders, peers, vendors, and clinical staff.
• Provide supporting documentation for audit findings using current coding guidelines, regulatory requirements, and organizational policies.
• Identify and immediately report adverse audit trends, compliance concerns, and potential areas of risk to leadership.
• Apply ICD-10-CM coding and CMS risk-adjustment guidelines.
• Manage multiple audits and projects while following different vendor guidelines.
• Meet stringent project deadlines and directives.
• Establish rapport and trust with clinical staff when discussing coding issues.
• Follow all established policies, procedures, regulatory requirements, accreditation standards, and professional guidelines.

Required Qualifications

• Bachelor's degree in healthcare administration or a related field, or equivalent relevant experience.
• At least four years of coding, auditing, or equivalent related experience.
• At least two years of risk-adjustment coding experience.
• Strong understanding of ICD-10-CM coding guidelines.
• Strong understanding of CMS risk-adjustment guidelines.
• Knowledge of anatomy, physiology, disease processes, and medical terminology.
• Strong organizational and interpersonal skills.
• Ability to communicate difficult or corrective information in a positive and professional manner.
• Ability to work across multiple projects and vendor requirements.
• Ability to communicate effectively with clinical staff, leadership, peers, and vendors.
• Current Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) certification is required.

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC) certification.
• Previous risk-adjustment auditing experience.
• Experience providing coding or compliance education to healthcare providers.
• Additional related education or professional experience.

Supervisory Responsibilities
None.
Physical and Work Environment Requirements

• Typical professional office environment.
• Extensive sitting with periodic standing and walking.
• Regular use of a computer, telephone, and general office equipment.
• Must be able to lift up to 20 pounds.
• Must have adequate visual acuity and the ability to communicate effectively through reading, writing, speaking, and telephone conversations.
• Occasional off-site travel may be required.