Risk Adjustment Data Validation (RADV) Auditor

The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with Centers for Medicare and Medicaid (CMS) and RADV guidelines. This role focuses on performing detailed audits, analyzing data, and collaborating with providers and internal teams to support Hierarchical Condition Categories (HCC) ratio goals and risk adjustment improvement initiatives. The auditor prepares customized reports based on data analysis and provides actionable recommendations to enhance operational and clinical performance. Additionally, the position assists in managing data collection processes and develops procedures for monitoring, validating, and reconciling data for accuracy. Working closely with cross-functional teams, the auditor supports compliance, quality assurance, and risk mitigation strategies while contributing to the development of tools and processes to improve coding accuracy and audit efficiency., Google IT Automation with Python Quality Auditor Aerotek

San Antonio, TX*On-Site

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San Antonio, TX*Hybrid

Auditing Research Medicare Medicaid Teaching Epic EMR Dashboard Leadership Innovation Compassion CPT Coding Communication Problem Solving Guest Relations Microsoft Office Inpatient Coding Clinical Research Critical Thinking Quality Assurance Outpatient Surgery Emergency Departments Utilization Management ICD Coding (ICD-9/ICD-10) Ancillary Medical Services Health Information Management Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) HEDIS (Healthcare Effectiveness Data And Information Set) +0

Medicaid Communication Data Analysis Detail Oriented Risk Mitigation Medical Records Problem Solving Data Collection Data Validation Quality Assurance Organizational Skills Procedure Development Electronic Medical Record ICD Coding (ICD-9/ICD-10) Medical Coding Certification Healthcare Industry Knowledge Health Information Systems (HIS) Certified Coding Specialist (CCS) Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC), Bachelor’s degree required. Coding certification (such as CPC, CRC, or CCS) is preferred, or candidates must demonstrate a willingness to obtain certification within 6-12 months of hire. Applicants should have 1-2 years of healthcare experience; prior coding experience is preferred. Strong analytical and problem-solving skills, coupled with attention to detail, are essential. Candidates must possess the ability to learn and apply ICD-10-CM coding principles, exhibit excellent communication and organizational skills. Proficiency in health information systems, electronic health records (EHRs), HEDIS, RADV, and claims data analysis is a plus.

LICENSURE/CERTIFICATION

Coding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Risk Adjustment Coder-CRC) Related Jobs Auditor, Risk Adjustment Data Validation University Health

San Antonio, TX*On-Site

Auditing Medicare Medicaid Communication Data Analysis Detail Oriented Risk Mitigation Medical Records Problem Solving Data Collection Data Validation Quality Assurance Organizational Skills Procedure Development Electronic Medical Record ICD Coding (ICD-9/ICD-10) Medical Coding Certification Healthcare Industry Knowledge Health Information Systems (HIS) Certified Coding Specialist (CCS) Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) HEDIS (Healthcare Effectiveness Data And Information Set) +0