Risk Auditor Resume Sample

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Edyth Thiel
8832 Kassulke Ferry,  San Francisco, CA
+1 (555) 424 3741

Work Experience

Credit Risk Review Senior Auditor
02/2017 - PRESENT
Houston, TX
  • Audits external vendors’ coding based on medical record reviews
  • Works on additional risk adjustment audit requests (i.e. outside auditors’ requests)
  • Performs quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-10 coding) for WellCare’s Medical Coding Specialists
  • Accountable for communicating QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics
  • Responsible for auditing external vendors’ coding based on medical record reviews
  • Responsible for conducting all activities in relation to CMS RADV audits: medical record review, identifying best medical record, submitting all necessary paperwork, transmitting data to CMS, responding to all inquiries, and providing expertise and support during the appeals process
  • Ensure compliance with the Company’s policies and procedures, applicable laws and regulations, accounting standards and keeping current on compliance related areas
  • Carry out Internal Audits vision and strategy conforming with Nomuras highest ethical standards
Risk Adjustment Auditor
01/2012 - 11/2016
Detroit, MI
  • Identify and communicate changes to the control environment and revisions to the risk assessments and audit plan
  • Deliver Audits/Projects within budget and timetable, in compliance with departmental standards and methodology
  • Adhere to the regulatory requirements of Internal Audit in the Risk Audits space
  • Communicate effectively with key stakeholders
  • Demonstrate leadership behaviours aligned to Nomuras culture
  • Clearly and accurately document the execution of specific audit procedures as defined by the projects’ objectives and planned audit approach. Prepare written reports, supporting audit opinions
  • Review the audit report and ensures that recommendations properly address the root cause of the identified anomalies, and that the executive summary reflects the strengths and weaknesses to be brought to management’s attention
  • Ensure timely and rigorous (i.e. reviewed, validated and well-documented) follow-up of internal audit or regulators’ recommendations
  • Specific subject matter expertise regarding technology application control disciplines and a solid business understanding of Foreign Exchange and Debt products, especially those associated with the Foreign Exchange and Local Markets business
Risk Auditor
09/2004 - 08/2011
Boston, MA
  • Assesses borrowers’ ability to repay according to terms and conditions
  • Evaluates high dollar claims for accuracy and completeness
  • Obtains facts to evaluate contract coverage
  • Provides timely contact with all required parties
  • Maintains quality claim files in accordance with appropriate best practices and claim handling file expectations
  • Communicate effectively with clients and co-workers
  • Be flexible and adaptable in a fast paced, team environment


Franciscan University of Steubenville
2000 - 2004
Bachelor's Degree in Accounting

Professional Skills

  • Demonstrates analytical/problem solving skills to perform a variety of complicated tasks
  • Strong presentation skills with diverse audience
  • Strong interpersonal skills and high level or professionalism
  • Strong analytical skills, particularly in regard to assessing the probability and impact of control weaknesses
  • Excellent communication and interpersonal skills, with the ability to present complex and sensitive issues to senior management and influence change
  • Strong understanding of financial products and experience of auditing sales and trading desks in a major bank.
  • Knowledge of MS Office functions with advanced Excel & Access skills to perform data analysis/test automated controls

How to write Risk Auditor Resume

Risk Auditor role is responsible for finance, retail, credit, securities, training, auditing, trading, reporting, insurance, travel.
To write great resume for risk auditor job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Risk Auditor Resume

The section contact information is important in your risk auditor resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Risk Auditor Resume

The section work experience is an essential part of your risk auditor resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous risk auditor responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular risk auditor position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Risk Auditor resume experience can include:

  • Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products
  • Knowledgeable and experienced with researching CMS and other sites for Risk Adjustment guidance
  • Group training experience is helpful
  • Demonstrated ability to provide proactive and creative solutions to business problems
  • Founded professional experience in CREDIT RISK MANAGEMENT by a large bank in Switzerland and/or
  • Experience in AUDIT of a related field

Education on a Risk Auditor Resume

Make sure to make education a priority on your risk auditor resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your risk auditor experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Risk Auditor Resume

When listing skills on your risk auditor resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical risk auditor skills:

  • Analysing MI and reviewing risk information to effectively support on identifying key business risks
  • Having open and effective discussions on key risks, engaging with business stakeholders, and on occasions coaching auditors
  • Driving the delivery of efficient and effective assurance
  • Previous lending experience in Business Banking or TDAF is considered an asset
  • Practices around building and validating risk models
  • Experience of working in a global financial services organisation with a conduct, compliance or regulatory focus

List of Typical Experience For a Risk Auditor Resume


Experience For Risk Adjustment Auditor Resume

  • Have (international) experience in complex organisations and knowledge of ING’s business and market risks, and associated controls
  • Are fluent in English and have a basic understanding of Dutch (fluency in other languages is much appreciated)
  • Assist in the audit close-out meeting and prepare draft audit findings which include the identified control deficiencies and recommendations
  • Are willing to travel 6-10 weeks per year
  • Have the ability to work at all levels in the organisation and are able to bridge between different people and different cultures

List of Typical Skills For a Risk Auditor Resume


Skills For Risk Adjustment Auditor Resume

  • Strong verbal and written communication skills with a high level of computer literacy
  • (International) experience in complex organisations and knowledge of ING’s business and market risks, and associated controls
  • Senior internal audit and/or risk experience (in a management or lead audit role) in a Bank or the Financial Services industry
  • Risk Adjustment methodology experience mandatory
  • Working knowledge of Banking products, services and processes
  • Performing review and analysis works, assessing risks for all types of risk measurement systems on the reviewed perimeter

Skills For Credit Risk Review Senior Auditor Resume

  • Issuing reports and proposing action plans or recommendations to the concerned RISK departments and beyond
  • Performing in-depth independent reviews, in accordance with the following points
  • Working with others to produce a final report compiling your findings into a high quality document
  • Working knowledge of MS Word, Excel and audit software tools
  • The ability to support and supervise the team through coaching, feedback and development, taking a proactive approach towards identifying and promoting talent
  • Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists
  • Exceptional knowledge of medical coding, billing systems and regulatory requirements
  • Sound understanding of the financial services industry

Skills For Risk & Control Framework Auditor Resume

  • AAPC or AHIMA coding certification is required
  • One of the following certifications are required: RHIT, RHIA, CPC, CPC-A, COC, CCS, CCS-P
  • Specialty/Department/Practice –Finance, HIM/Coding, Clinical Documentation Accuracy
  • One of the following certifications are required: RHIT, RHIA, CPC, COC, CCS, or CCS-P
  • Continue self-development to expand or maintain an understanding of the business line’s key processes and business applications
  • Knowledge of financial markets with a broad understanding market risk concepts and measurement of risks
  • In depth knowledge of business processes within Business Banking, TD Auto Finance or Credit Risk Management is considered a significant asset
  • Enterprise level risk assessment and risk reporting
  • Mentor and lead Risk Adjustment Auditor I’s, including the review of scorecards

Skills For Telecommuter Risk Adjustment Auditor Resume

  • Support coder instruction in HCC’s and Risk Adjustment auditing
  • Multi-tasking ability to handle requests
  • Conducts initial retrospective chart audit, documents discrepancies, and identifies accurate coding opportunities
  • Participates in quality coding initiatives as appropriate or assigned
  • Annual public transport pass (OV-jaarkaart)
  • A detailed knowledge of the regulatory environment we work in
  • Experience concentrated in credit review or credit risk lending functions with solid working knowledge of regulatory matters in credit risk functions, loan review or commercial lending
  • Big 4 audit, bank/financial institution regulatory/ supervisory or internal audit experience at a global investment bank
  • General knowledge of the Bank’s organizational structure

Skills For Internal Risk Auditor Resume

  • Desire to obtain CRC certification
  • Guarantee applicability of regulatory standards, internal procedures, internal systems and compliance
  • Findings are presented to line management with some assistance from more senior audit personnel
  • Perform out of state travel up to 15%
  • Specific subject matter expertise regarding technology application control disciplines and a solid business understanding of Credit Risk Management concepts, especially those associated with the Lines of Businesses (LOBs) that extend credit to corporations – Institutional Clients Group (ICG), Commercial Banking, etc
  • Highly motivated self starter with ability to multitask and complete assignments within time constraints and deadlines. Individual with desire to learn and teach others, positive attitude
  • In-depth knowledge of Retail and Business Banking processes related to Product Groups, Cards, Auto Finance, Business Banking and Risk Management
  • CPC, COC, CCS, CCS-P, CIC, CFPC, CEMC, RHIT, or RHIA Certification Required
  • Internal Capital Adequacy Assessment Process

Skills For Credit Risk Management Internal Auditor Resume

  • Intermediate level with Microsoft Word, Microsoft Power Point, Microsoft Excel
  • Knowledgeable of Medicaid, Medicare, Exchange
  • Knowledgeable of ICD-10 and CPT codes
  • Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products
  • Advanced knowledge and understanding of risk adjustment, coding and documentation requirements
  • Integrated Stress Testing
  • Specialty/Department/Practice – Comprehensive Care Management

Skills For Auditor, Risk Adjustment Resume

  • Shift/Schedule – FT Days
  • Maintains knowledge of AHA Coding Clinic and ICD-CM (ICD-10) Official Guidelines for Coding and Reporting, and possesses the ability to share this knowledge with physicians and other patient care team members in a professional, simplified and concise manner
  • Code and recheck all diagnoses and procedures using ICD-CM (and ICD-10) and CPT-4 codes adhering to all official coding guidelines, federal and state regulations, health system and departmental policies and productivity standards
  • Performs over-reads on vendor coding
  • Assess and develop understanding of physician documentation to assure it meets standards and supports the diagnosis selected
  • Review appropriate provider documentation to determine diagnostic codes

Skills For Business Risk Manager / IT Auditor Resume

  • Assist in preparation and implementation of necessary internal controls for related entities consistent with CMS and State requirements and to support RADV or other regulatory audits
  • Works with cross-functional team to monitor progress of health partners to ensure Risk Adjustment Guidelines set for the by CMS are being followed
  • Specialty/Department/Practice – Risk Adjustment- Coding
  • Specialty/Department/Practice –HIM/ Coding
  • Delivers audit results to provider/provider office in any of the four states we have products
  • In depth knowledge of EMR systems and system logic

Skills For Assigned Risk Premium Auditor Resume

  • Familiar with Hospital and provider operations
  • Exposure to financial products, risk management methodologies (“Greeks”, VaR, Stress, etc.), valuation concepts, and/or market risk regulatory aspects (CCAR stress testing, Basel Market Risk Rule) desirable
  • Location/Facility – Baylor Main Hospital Temple- Ground Floor
  • Location/Facility – Baylor Main Hospital - Ground Floor
  • Specialty/Department/Practice – Dallas
  • Location/Facility – Remote

Skills For Operations Risk Auditor Resume

  • Location/Facility – Dallas
  • Shift/Schedule – Days
  • Shift/Schedule - Days
  • 13th month's salary
  • 27 days holiday
  • Job scale 10

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