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$71.8K

$108K

How much do radv audit jobs pay per year?

As of Jun 29, 2026, the average yearly pay for radv audit in the United States is $71,776.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,500.00 and $81,500.00 per year, depending on experience, location, and employer.

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 type of auditor gets paid the most?

In auditing, forensic auditors and senior-level auditors tend to earn the highest salaries due to their specialized skills and experience. Certified Public Accountants (CPAs) with advanced certifications and extensive experience often command higher pay, especially in senior or managerial roles within large organizations or consulting firms.

What are the two types of RADV audits?

In Radv Audit roles, the two main types of RADV (Risk Adjustment Data Validation) audits are prepayment audits, which review data before claims are paid, and postpayment audits, which verify the accuracy of claims after payment. Both types aim to ensure proper billing and prevent fraud, requiring auditors to analyze medical records and claims data thoroughly.

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.

Is an auditor a high paying job?

Auditors, including those in Radv Audit roles, often earn competitive salaries that vary based on experience, location, and industry. Entry-level positions typically have lower pay, while experienced auditors with certifications like CPA can earn higher salaries, especially in large firms or financial centers.

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.

Who performs a radv audit?

A RADV (Risk Adjustment Data Validation) audit is typically performed by government auditors or contracted third-party organizations to verify the accuracy of Medicare Advantage risk adjustment data. These audits assess whether diagnoses submitted by healthcare providers are supported by medical records and are conducted periodically to ensure compliance and prevent fraud.
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Radv Audit jobs near you
Provider Education Specialist

Provider Education Specialist

Community Medical Group

Miami, FL • On-site

Full-time

Posted 6 days ago

Job description

Position Summary

The APRN – Provider Education Specialist is responsible for delivering education, coaching, and performance support to Advanced Practice Providers (APRNs/PAs) and Physicians to enhance clinical documentation accuracy, risk adjustment capture, and quality outcomes in a value-based care environment. This role serves as a clinical subject matter expert in HCC documentation, CMS risk adjustment guidelines, and quality measures, translating regulatory and clinical requirements into practical, provider-focused education.

The Provider Education Specialist partners closely with Clinical Affairs, Quality, Coding, and Operations teams to support provider performance, compliance, and improved patient outcomes across the organization.

Key Responsibilities

  • Develop and deliver onboarding and ongoing education for APRNs, PAs, and Physicians related to risk adjustment, quality measures, and documentation standards.
  • Provide training on HCC capture, diagnosis specificity, chronic condition documentation, and annual reassessment requirements.
  • Translate CMS, ICD-10, and organizational requirements into clear, clinically relevant guidance for providers.
  • Educate providers on compliant documentation practices aligned with Medicare Advantage and CMS standards.
  • Reinforce best practices to support accurate risk representation and continuity of care.
  • Collaborate with Coding and Clinical Documentation Improvement (CDI) teams to address audit findings, documentation gaps, and trends.
  • Train providers on quality metrics, preventive care standards, and chronic disease management expectations.
  • Support initiatives focused on care gap closure, quality score improvement, and patient outcomes.
  • Provide targeted coaching based on performance dashboards, audits, and quality reports.
  • Build strong, collaborative relationships with providers across disciplines.
  • Conduct one-on-one and group coaching sessions to reinforce expectations and drive performance improvement.
  • Serve as a trusted clinical education resource for documentation, risk adjustment, and quality-related questions.
  • Review provider performance data, audit results, and quality reports to identify education opportunities.
  • Partner with leadership to develop targeted education plans and improvement strategies.
  • Track training effectiveness and recommend enhancements to education content and delivery.


Required Qualifications

  • Active, unrestricted APRN license
  • Minimum 3 years of clinical practice experience
  • Demonstrated knowledge of:
    • Risk adjustment and HCC documentation
    • Medicare Advantage and value-based care models
    • Clinical documentation improvement (CDI)
  • Strong communication, facilitation, and coaching skills


Preferred Qualifications

  • Experience training or mentoring providers
  • Background in Quality, Risk Adjustment, Population Health, or CDI
  • Familiarity with CMS guidelines, RADV audits, and quality programs
  • Experience working in a multi-site or medical group environment


Core Competencies

  • Provider education and adult learning principles
  • Clinical documentation expertise
  • Risk adjustment and quality knowledge
  • Influence without authority
  • Data-driven coaching and problem solving
  • Relationship building and provider engagement