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Radv Audit Jobs (NOW HIRING)

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Develops and implements strategies to improve RADV performance, reduce audit exposure, and strengthen documentation standards over time. * Produces and maintains comprehensive performance reporting ...

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.

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA

$137K - $184K/yr

Develops and implements strategies to improve RADV performance, reduce audit exposure, and strengthen documentation standards over time. * Produces and maintains comprehensive performance reporting ...

RELI Group Inc.

Senior Medical Coder

Baltimore, MD · On-site +1

$65K - $75K/yr

... 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 ...

RELI GROUP INC

Senior Medical Coder

Baltimore, MD · On-site

$65K/yr

... 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 ...

RELI GROUP INC

Senior Medical Coder

Baltimore, MD

$65K/yr

... 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 ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site +1

$19.25 - $25.75/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.

eTeam

Medical Coder

Newark, NJ · On-site

$40 - $42/hr

This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and ...

RELI Group

Senior Medical Coder

Baltimore, MD · On-site +1

$65K - $75K/yr

... 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 ...

ICONMA

Professional Coder I

Newark, NJ · On-site

This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and ...

Harris Health System

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 ...

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All JobsRadv Audit Jobs

Radv Audit information

See salary details

$25K

$71.8K

$108K

How much do radv audit jobs pay per year?

As of Jun 30, 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

Sr. Manager, Risk Adjustment & Quality

Centrum Health

Doral, FL • On-site

Other

Posted 17 days ago

Key responsibilities

  • Manage a team of Risk Adjustment Coders, HEDIS specialists, Billers, and Auditors to oversee daily billing and coding operations.

  • Provide leadership and program management for risk adjustment, medical records, coding, and billing operations across multiple lines of business.

  • Collaborate with internal teams to develop tools and strategies for risk adjustment and quality initiatives, ensuring compliance with federal and state regulatory requirements.

Job description

Centrum Health's Sr. Manager of Risk Adjustment and Quality will be responsible for managing a team of Risk Adjustment Coders, HEDIS specialists, Billers, and Auditors to maintain daily billing and coding operations for our wholly owned clinics and affiliated practices. In this role, the candidate must excel at cross-departmental collaboration with Physicians, Clinical Operations, Data/Technology, and Finance teams.

The individual must be a subject matter expert in ACA, Medicare Advantage, Medicaid risk adjustment, billing, and quality operations. The position delivers best-in-class results while operating under strict regulatory adherence and a strong compliance mindset.

This is an onsite position in Doral, FL.

ROLE RESPONSIBILITIES

The core function of this role includes management of risk adjustment, medical records, coding, and billing operations.
Lead a team to drive risk adjustment performance across Medicare Advantage, ACO, Medicaid, and ACA lines of business.
Provide thought leadership in the continued development of the Risk Adjustment and Quality function, including collaboration with analytics and internal technology teams to develop a Risk Adjustment and Quality Suspecting Engine.

Work closely with internal technical teams to develop in house tools to support Risk Adjustment operations.
Provide leadership and overall program management for retrospective and prospective encounter facilitation, supplemental data submission, virtual visits, and in-office assessments.
Collaborate with Actuarial and Analytics teams to design and implement suspecting and segmentation strategies for prospective and retrospective programs.
Develop short-term, quick-win initiatives as well as long-term, analytics-driven gap-closure programs and tools.
Communicate complex concepts to non-technical business stakeholders across the full business cycle-from question identification through results interpretation-including data integrity considerations.
Ensure Centrum Health's ability to meet federal and state regulatory compliance and reporting requirements, including RADV audits, on an annual basis.
Perform other duties and responsibilities as assigned.
This position will have direct and indirect supervisory responsibility for risk adjustment program execution and analytics functions.
Occasional travel may be required.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor's degree in a healthcare-related field or equivalent experience, required.
  • Six (6) or more years of experience in healthcare Risk Adjustment required.
  • Experience working with primary care providers and practices in value-based care.
  • Three (3) or more years of leadership experience managing and mentoring teams.
  • CPC, CRC, and CPMA certifications are highly preferred.
  • Experience working with Medicare Advantage, ACA, and Medicaid health plans is preferred.
  • Working knowledge of business intelligence tools and their application in driving business decisions.
  • Experience with in-home and virtual engagement capabilities, preferred.
  • Bilingual in Spanish and English required.

PROFESSIONAL COMPETENCIES

Ability to lead and mentor a highly skilled team.
Ability to frame and execute end-to-end analyses in collaboration with business and technical stakeholders.
Expertise in advanced data analysis to identify opportunities and design programs to capture value.
Experience managing third-party service providers, including TPAs and medical record/chart retrieval functions.
Eager learner; collaborative partner; clear communicator; and detail-oriented analyst.
Strong passion for empirical research and data-driven decision-making.
Experience maintaining payer file integrations and developing performance dashboards using data from multiple reporting sources.

Apply