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# Risk Adjustment Data Validation (RADV) Auditor

- **Company:** CareerCircle
- **Location:** San Antonio, TX, United States
- **Experience:** Starter
- **Contract:** Permanent contract
- **Skills:** Artificial Intelligence, Data Analysis, Computer Programming, Data Validation, Health Information Management, Health Information Systems (HIS), Healthcare Effectiveness Data and Information Set, Python (Programming Language), Microsoft Office, Electronic Medical Records
- **Published:** September 3, 2026
- **Apply:** https://www.careercircle.com/jobs/all/all/usa/tx/san-antonio/73c949c6-266b-4c1d-8fb1-4502118fcb2e

## About the Role

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)
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## Description

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
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