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Radv Audit Jobs (NOW HIRING)

Strive Health

Manager, Coding Operations

Denver, CO · On-site

ICD 10-CM, CPT, HCPCS, DRG, HCC coding and RADV audits). * Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, RADV Audits, and review of CPT and CPT II codes as applicable.

Strive Health

Manager, Coding Operations

Denver, CO · Remote

$85K - $104K/yr

ICD 10-CM, CPT, HCPCS, DRG, HCC coding and RADV audits). * Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the ...

RELI GROUP INC

Senior Medical Coder

Baltimore, MD

... Part C audit, include an acceptable physician/practitioner signature, and review submitted ... Provide Appeals support as RADV Subject Matter Expert at CMS request * Participate and contribute ...

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Radv Audit information

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$25K

$71.8K

$108K

How much do radv audit jobs pay per year?

As of Jun 6, 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 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.
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Radv Audit jobs near you
Infographic showing various Radv Audit job openings in the United States as of May 2026, with employment types broken down into 90% Full Time, and 10% Contract. Highlights an 60% In-person, and 40% Remote job distribution, with an average salary of $71,776 per year, or $34.5 per hour.
Certified Risk Adjustment Coder (CRC), Senior Associate

Certified Risk Adjustment Coder (CRC), Senior Associate

Ankura

Manhattan, NY • Remote

$85K - $200K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Ankura is a team of excellence founded on innovation and growth. Practice Overview: Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills.

Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience.

The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the largest and most prominent US health care providers, payers, and law firms.

Role Overview: Our Sr. Associates use their experience and knowledge related in coding, revenue cycle and clinical operations, along with their project management capabilities, to contribute to complex investigations, whistleblower lawsuits, internal investigations, payer/provider disputes, and acquisition due diligence, among others. Responsibilities: Review, analyze, and code diagnoses based on information in a patient's medical record according to specific guidelines for each project.

Evaluate compliance with established ICD-10 CM, third party reimbursement policies, regulations and accreditation guidelines. Communicate effectively with internal and external stakeholders according to project requirements Works with Project Managers to understand client needs and develop project work plans accordingly Understands Healthcare Compliance concepts, issues, and how to research and access regulatory guidelines and reference materials Drafts clear and concise analyses of medical record review and coding findings Ensures successful completion of project deliverables as assigned and within the desired timeframe Works collaboratively with Ankura team members focusing on building and maintaining internal and external client and counsel relationships Identifies opportunities for cross practice collaboration Proven writing and presentation skills and has a keen sense of attention to detail Communicates findings of concern with the team and Project Manager as they are identified Can independently deliver work and seeks to gain additional opportunities for development in a variety of risk adjustment related areas. Qualifications: Certified in Risk Adjustment Coding (CRC) with at least five (5) recent years of experience in HCC/Risk Adjustment and/or RADV Audit Methodology Associate's or Bachelor's degree preferred, but not required Strong understanding of clinical terminology, disease processes, anatomy and pharmacology.

Intermediate to advanced understanding of in claims processing procedures, state and federal regulations, and Medicare Part D requirements. Excellent written and verbal communication skills, ability to work in a remote environment, and time management skills. Prior success in managing small projects and teams and able to Ability to be able work on multiple client projects simultaneously, if needed.

Ability to work in a fast-paced environment while maintaining high quality Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings Understands the importance of attorney-client privileged and confidential communication Willingness to travel when needed Willingness to perform a variety of skill based tasks related to risk adjustment work Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future. For individuals assigned and/or hired to work in California, Colorado, or New York, Ankura is required to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the said markets and considers a broad range of factors including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs.

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. The range does not include additional benefits outside of salary. At Ankura, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each role.

A reasonable estimate of the current base pay range is between $85,000 to $200,000; this range is not a promise of a particular wage. Ankura is an Affir... [continues with the full EEO statement exactly as provided] #J-18808-Ljbffr

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