Oversee RADV/HCC audits and documentation improvement strategies * Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements * Identify opportunities to ...
Oversee RADV/HCC audits and documentation improvement strategies * Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements * Identify opportunities to ...
Senior Manager, Corporate Compliance - Risk Adjustment
Irving, TX · On-site
$75K - $165K/yr
Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits Education Bachelor's degree in Health ...
Senior Manager, Corporate Compliance - Risk Adjustment
Irving, TX · On-site
$75K - $165K/yr
Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits Education Bachelor's degree in Health ...
Director, Clinical Documentation Improvement
$76K - $104K/yr
Compliance and Audit Oversight ● Establish and maintain a robust compliance framework for all risk adjustment activities, ensuring alignment with CMS guidelines, RADV audit standards, and payer ...
Quick apply
Director, Clinical Documentation Improvement
$76K - $104K/yr
Compliance and Audit Oversight ● Establish and maintain a robust compliance framework for all risk adjustment activities, ensuring alignment with CMS guidelines, RADV audit standards, and payer ...
Director, Clinical Documentation Improvement
Houston, TX · On-site
$76K - $104K/yr
Compliance and Audit Oversight • Establish and maintain a robust compliance framework for all risk adjustment activities, ensuring alignment with CMS guidelines, RADV audit standards, and payer ...
Director, Clinical Documentation Improvement
Houston, TX · On-site
$76K - $104K/yr
Compliance and Audit Oversight • Establish and maintain a robust compliance framework for all risk adjustment activities, ensuring alignment with CMS guidelines, RADV audit standards, and payer ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · On-site
$22.10 - $38.25/hr
... 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 ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · On-site
$22.10 - $38.25/hr
... 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 ...
... 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 ...
New
... 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 ...
New
... 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 ...
... 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 ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · Remote
$22.10 - $38.25/hr
... 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 ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · Remote
$22.10 - $38.25/hr
... 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 ...
Hierarchical Condition Category (HCC) Coding Specialist
Austin, TX · On-site
$41.85/hr
... RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
Hierarchical Condition Category (HCC) Coding Specialist
Austin, TX · On-site
$41.85/hr
... RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
... audit readiness directly drive financial and compliance outcomes. You will sell to the leaders who ... models, RADV, quality programs, value-based care, and the competitive landscape) to engage ...
... audit readiness directly drive financial and compliance outcomes. You will sell to the leaders who ... models, RADV, quality programs, value-based care, and the competitive landscape) to engage ...
... audit readiness directly drive financial and compliance outcomes. You will sell to the leaders who ... models, RADV, quality programs, value-based care, and the competitive landscape) to engage ...
... audit readiness directly drive financial and compliance outcomes. You will sell to the leaders who ... models, RADV, quality programs, value-based care, and the competitive landscape) to engage ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
... assurance audits, and collaborating with multiple departments across the organization. JOB ... Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
... assurance audits, and collaborating with multiple departments across the organization. JOB ... Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
... assurance audits, and collaborating with multiple departments across the organization. JOB ... Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
... assurance audits, and collaborating with multiple departments across the organization. JOB ... Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and ...
Auditor, Risk Adjustment
Dallas, TX · Remote
$82K - $108K/yr
Certified professional coder (CPC) * 3+ year(s) retrospective risk adjustment coding experience. * 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV ...
Quick apply
Auditor, Risk Adjustment
Dallas, TX · Remote
$82K - $108K/yr
Certified professional coder (CPC) * 3+ year(s) retrospective risk adjustment coding experience. * 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV ...
Radv Audit information
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 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 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 the difference between Radv Audit vs Radv Analyst?
| Aspect | Radv Audit | Radv Analyst |
|---|---|---|
| Certifications | CPA, CIA, CISA | CPA, CIA, CISA |
| Work Environment | Audit firms, corporate audit departments | Financial institutions, consulting firms |
| Primary Focus | Evaluating internal controls, compliance, and financial accuracy | Analyzing 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.
Who performs a Radv Audit?
A Radv (Reasonable Accommodation and Disability Verification) audit is typically performed by trained compliance or HR professionals, auditors, or disability specialists who review documentation and processes to ensure adherence to accommodation policies and legal requirements. These professionals often have knowledge of disability laws and may use specialized tools or checklists during the audit process.
What are popular job titles related to Radv Audit jobs in Texas?
For Radv Audit jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Radv Audit jobs in Texas look for?
The top searched job categories for Radv Audit jobs in Texas are:
What cities in Texas are hiring for Radv Audit jobs?
Cities in Texas with the most Radv Audit job openings:
Full-time
Re-posted 8 days ago
Job description
Description:
VMG Health supports a nationwide network of clients with over 70,000 engagements, exclusively in the healthcare industry. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. VMG Health provides a solutions-oriented approach to client needs through our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients’ valuation, strategic, and compliance needs.
Requirements:We are seeking an experienced Director to support the continued growth of our Coding, Audit, Compliance, and Revenue Cycle Management (RCM) consulting practice. This role will provide strategic leadership across client engagements, with a particular focus on coding compliance, revenue cycle operations, and risk adjustment (RADV/HCC).
The Director will play a key role in designing and delivering provider-focused education and training programs across multiple specialties, supporting documentation improvement, coding accuracy, and overall compliance.
This individual will lead complex engagements, guide high-performing teams, and partner with clients to develop actionable, compliant, and operationally effective solutions. This is a highly visible, client-facing role with opportunities to contribute to service line innovation and business development.
Key Responsibilities
Client Engagement & Leadership
- Provide strategic oversight for coding, audit, compliance, and revenue cycle engagements
- Serve as a trusted advisor to clients, delivering clear, actionable recommendations
- Ensure delivery of accurate, high-quality, and audit-defensible work products
- Lead executive-level presentations and client discussions
Revenue Cycle & Risk Adjustment Expertise
- Lead and advise on RCM initiatives, including coding, billing, audit, and revenue integrity
- Oversee RADV/HCC audits and documentation improvement strategies
- Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements
- Identify opportunities to improve reimbursement, risk capture, and operational performance
Team Leadership & Development
- Mentor and develop Managers, Auditors, and consulting staff
- Provide guidance on engagement execution, quality standards, and client communication
- Foster a collaborative, high-performing team environment
Business Development
- Develop and maintain client relationships to support growth
- Identify and pursue new business opportunities
- Participate in proposals, presentations, and industry events
- Contribute to thought leadership, including publications and speaking engagements
Qualifications
Experience
- 8+ years of healthcare industry experience
- Proven experience in Revenue Cycle Management (RCM) and healthcare operations
- Demonstrated expertise in HCC/risk adjustment coding and documentation
Technical Expertise
- Strong knowledge of:
- ICD-10-CM, CPT®, and HCPCS coding
- E/M documentation guidelines
- CMS regulations and payer requirements
- Revenue cycle processes (coding, billing, denials, reconciliation)
Credentials
- CPC, CPMA, CRC required
- Bachelor’s degree preferred
Skills & Competencies
- Strong analytical and problem-solving abilities
- Excellent written and verbal communication skills
- Executive presence and client-facing experience
- Ability to manage multiple complex projects simultaneously
- Detail-oriented with a strong focus on quality and compliance
About VMG Health
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
51 - 200 Employees
Headquarters location
Dallas, TX, US
Year founded
1995