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What are some common challenges faced by professionals in a RADV audit role, and how can they be addressed?

Professionals in a Radv Audit role often encounter challenges such as managing tight deadlines, navigating complex regulatory requirements, and ensuring accuracy in documentation. Collaborating closely with cross-functional teams and maintaining clear communication with stakeholders can help mitigate misunderstandings and streamline the audit process. Staying updated with current industry standards and leveraging audit management tools are also crucial for maintaining efficiency and compliance. Proactively seeking feedback and participating in continuous learning opportunities can further enhance performance in this role.

What is a RADV audit?

A RADV (Risk Adjustment Data Validation) Audit is a process used by the Centers for Medicare & Medicaid Services (CMS) to verify the accuracy of diagnosis codes submitted by Medicare Advantage organizations. The purpose is to ensure that health plans are being compensated appropriately based on the health status of their members. During a RADV audit, patient medical records are reviewed to confirm that the diagnoses used for risk adjustment are supported by documentation. This helps prevent overpayments and ensures compliance with federal regulations. Organizations found to have unsupported diagnoses may be required to repay funds to CMS.

What is the difference between Radv Audit vs Radv Analyst?

AspectRadv AuditRadv Analyst
CertificationsCPA, CIA, CISACPA, CIA, CISA
Work EnvironmentAudit firms, corporate audit departmentsFinancial institutions, consulting firms
Primary FocusEvaluating internal controls, compliance, and financial accuracyAnalyzing risk, data, and financial reports to support audits

Radv Auditors primarily focus on evaluating internal controls and ensuring compliance through audits, while Radv Analysts analyze data and risks to support audit processes. Both roles require similar certifications and often work in related environments, but their core responsibilities differ in scope and focus.

What key skills and qualifications are needed to thrive as a RADV auditor, and why are they important?

To excel as a RADV (Risk Adjustment Data Validation) Auditor, you need a solid understanding of medical coding, healthcare regulations, and risk adjustment methodologies, typically supported by credentials like CPC, CRC, or RHIA. Familiarity with audit software, electronic health records (EHRs), and CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication are important soft skills for interpreting data and conveying findings. These skills ensure accurate validation of medical records, compliance with regulatory standards, and the integrity of healthcare reimbursement processes.

What are popular job titles related to Radv Audit jobs in Minnesota?

For Radv Audit jobs in Minnesota, the most frequently searched job titles are:

What job categories do people searching Radv Audit jobs in Minnesota look for?

The top searched job categories for Radv Audit jobs in Minnesota are:

What cities in Minnesota are hiring for Radv Audit jobs?

Cities in Minnesota with the most Radv Audit job openings:

Radv Audit jobs near you

Remote Risk Adjustment Coding Auditor

TEKsystems

Saint Paul, MN • Remote

$32 - $37/hr

Contractor

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Risk Adjustment Coding Auditor (Remote)

Location: 100% Remote (Approved U.S. States Only)

Employment Type: Contract (5 Months)

Schedule: First Shift

Overview

We are seeking experienced Risk Adjustment Coding Auditors to support a growing healthcare organization during a high-volume operational period. This role is ideal for professionals with deep expertise in HCC coding, risk adjustment auditing, and regulatory compliance who thrive in a production-driven environment.

This position offers the opportunity to work remotely while contributing to the accuracy, integrity, and compliance of risk adjustment programs that support quality healthcare outcomes and reimbursement processes.

Key Responsibilities
  • Audit risk adjustment codes for accuracy, consistency, and compliance with coding guidelines and best practices
  • Perform retrospective and prospective medical record reviews
  • Validate diagnosis coding based on provider documentation and CMS-HCC requirements
  • Identify coding and documentation gaps that impact risk adjustment reporting
  • Ensure compliance with HIPAA, privacy, security, and regulatory requirements
  • Provide written and verbal feedback regarding coding errors, trends, and improvement opportunities
  • Support audit initiatives, production goals, and special projects
  • Act as a subject matter expert on risk adjustment coding and audit practices
  • Complete audit deliverables within established timelines and quality standards
Required Qualifications
  • 7+ years of relevant professional experience
  • 5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines
  • 5+ years of Risk Adjustment audit experience
  • 1+ year working in a production-based environment
  • CRC (Certified Risk Adjustment Coder) certification in good standing
  • Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models
  • Experience communicating coding findings and audit outcomes to stakeholders
  • Intermediate proficiency with Microsoft Office (Excel, Word, Outlook, PowerPoint)
  • Strong analytical, organizational, and critical thinking skills
  • High School Diploma or equivalent
  • Authorized to work in the United States without sponsorship
Preferred Qualifications
  • Bachelor's Degree
  • RHIT or RHIA certification with strong risk adjustment coding experience
  • HEDIS and/or STARS experience
  • Provider education experience
  • RADV audit experience
  • CPMA or additional coding certifications
  • Experience with NLP software platforms
Preferred Skills
  • Risk Adjustment
  • HCC Coding
  • Medical Coding Audits
  • Healthcare Compliance
  • Medicare Risk Adjustment
  • Documentation Review
  • CMS-HCC Methodology
  • Clinical Documentation Improvement
Work Environment
  • Fully remote position
  • First shift schedule
  • Collaborative healthcare-focused team environment
  • Potential for future extension or conversion based on business needs and performance
Eligible States

Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, and Wisconsin.

Interested candidates should have a strong background in risk adjustment auditing, HCC coding, and healthcare compliance, along with an active CRC certification.

#centralpriority26

Job Type & Location

This is a Contract position based out of St Paul, MN.

Pay and Benefits

The pay range for this position is $32.00 - $37.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Aug 14, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

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