Risk Adjustment Nurse Auditor - Corporate Compliance - Position #2019-370


Date Posted:
Full Time
Open until filled - Redlands - Monday - Friday - 8:00a.m. - 5:00p.m.

Job Description

The Risk Adjustment Nurse Auditor position performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered to Medicare Advantage patients is complete, compliant and accurate to support optimal reimbursement based upon industry accepted clinical guidelines. This position conducts audits that require significant independent decision making and is considered the expert in accomplishing the quality of the processes to ensure optimum reimbursement.  The Risk Adjustment Nurse Auditor develops the clinical operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment. This position supports and aligns planning to ensure that key strategic activities aimed at risk adjustment management initiatives are implemented and goals are met. 



High School Diploma or equivalent. Graduation from a school of nursing. Associated Degree preferred. At least two years’ experience as an RN in a clinical setting. Five years in outpatient clinical setting with two or more years of experience in the education/training of clinical staff preferred. Current State of California RN licensure. Current BLS (American Heart Association) & CPC or CRC certification. Extensive knowledge of internal medical group operations and a high degree of interpersonal skills are required.  Must be proficiently skilled in the application and use of Windows, Word, PowerPoint, Excel, GroupWise and the Internet. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.


Applications must be complete and demonstrate that the minimum qualifications are met. Resumes may be attached to completed application form as supplemental information, but will not be accepted in lieu of an official application form. Applications will be screened and the most qualified candidates who best match the needs of the position will be invited to compete further in the recruitment process. Due to the large volume of applications received, we are unable to track for individual applications or discuss the application process.