As a Coding Quality Assurance (QA) Manager , you will lead a high-performing team of QA Specialists ... Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare ...
As a Coding Quality Assurance (QA) Manager , you will lead a high-performing team of QA Specialists ... Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare ...
Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only
Atlanta, GA · On-site
... server, RADV/IVA audits), HCC coding models (CMS-HCC, HHS-HCC), ICD-10 codes, and claims data Exp. Consultant LinkedIn profile must have been created before 2018/2019 Need 8-10+yrs of IT Exp.
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Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only
Atlanta, GA · On-site
... server, RADV/IVA audits), HCC coding models (CMS-HCC, HHS-HCC), ICD-10 codes, and claims data Exp. Consultant LinkedIn profile must have been created before 2018/2019 Need 8-10+yrs of IT Exp.
Hierarchical Condition Category (HCC) Coding Specialist
Atlanta, GA · 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
Atlanta, GA · 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.
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Radv Coding information
What is a RADV coder?
A RADV Coder, or Risk Adjustment Data Validation Coder, is a professional who reviews and validates medical records to ensure accurate diagnosis coding for risk adjustment in healthcare plans, particularly for Medicare Advantage and ACA programs. Their primary role is to confirm that submitted diagnosis codes accurately reflect patients' health conditions, supporting compliance with federal regulations. RADV Coders help healthcare organizations avoid errors in risk adjustment submissions, which can impact reimbursement and regulatory standing. They must be knowledgeable in ICD-10 coding, risk adjustment guidelines, and medical record documentation.
What skills and qualifications are needed to thrive as a RADV coder?
To thrive as a RADV (Risk Adjustment Data Validation) Coder, you need expertise in medical coding, knowledge of risk adjustment models, and familiarity with ICD-10-CM guidelines, often backed by certifications like CPC or CRC. Experience with coding software, EHR systems, and risk adjustment tools is typically required. Attention to detail, analytical thinking, and strong communication skills are vital for ensuring coding accuracy and collaborating with healthcare teams. These skills and qualifications are crucial for maintaining compliance, optimizing reimbursement, and supporting accurate healthcare data reporting.
What are common challenges faced by a RADV coder, and how can they be managed?
RADV Coding professionals often encounter challenges such as keeping up with evolving regulatory requirements, ensuring high levels of coding accuracy, and managing tight deadlines during audit cycles. Effective management of these challenges involves regular training on updated guidelines, leveraging coding tools or software to enhance efficiency, and collaborating closely with compliance and clinical teams to clarify documentation. Building strong organizational and communication skills is also key to thriving in this fast-paced environment.
What is the difference between Radv Coding vs Medical Billing Specialist?
| Aspect | Radv Coding | Medical Billing Specialist |
|---|---|---|
| Credentials | Certification (e.g., AAPC, AHIMA), coding credentials | Billing and coding certifications, but often less specialized |
| Work Environment | Hospitals, clinics, outpatient facilities | Medical offices, billing companies, healthcare providers |
| Industry Usage | Used for accurate coding for reimbursement and records | Handles billing, claims submission, and payment processing |
| Search & Comparison Intent | Focuses on coding accuracy and compliance | Focuses on billing processes and claims management |
Radv Coding primarily involves assigning accurate medical codes for radiology procedures, ensuring compliance and reimbursement. Medical Billing Specialists handle the billing process, submitting claims and managing payments. While both roles work closely within healthcare revenue cycle management, Radv Coders focus on coding accuracy, whereas Billing Specialists focus on financial transactions.
What are popular job titles related to Radv Coding jobs in Georgia?
For Radv Coding jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Radv Coding jobs in Georgia look for?
The top searched job categories for Radv Coding jobs in Georgia are:
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 6 days ago
Job description
As a Coding Quality Assurance (QA) Manager, you will lead a high-performing team of QA Specialists at the intersection of clinical precision and operational excellence. You'll drive coding accuracy, build robust Standard Operating Procedures (SOPs), and ensure full audit readiness by evaluating documentation from both our internal CDI team and external partners. If you bring deep expertise in Risk Adjustment and Hierarchical Condition Categories (HCC) alongside a passion for mentoring talent and elevating compliance standards, this role offers a direct platform to shape our quality operations and make a measurable impact.
Candidates should be comfortable working remotely from anywhere within the US, across all US time zones.
Primary Duties
- Team Leadership & Oversight: Lead, mentor, and manage a team of QA Specialists. Establish team goals, monitor productivity, conduct regular performance reviews, and foster a culture of continuous learning.
- Quality Audits: Oversee and perform comprehensive quality assurance reviews for coding completed by internal CDI staff and external vendor partners, ensuring compliance with official ICD-10-CM guidelines and risk adjustment models.
- SOP & Guideline Development: Design, implement, and maintain standard operating procedures, audit workflows, scoring methodologies, and coding quality guidelines across the organization.
- Payer Audit Support: Act as a key subject matter expert (SME) during external payer audits (e.g., RADV, Medicare, Commercial). Assist with chart selection, review, dispute documentation, and appeal responses.
- Vendor Management: Evaluate third-party coding vendor accuracy rates against established SLAs. Deliver constructive feedback, identify trend errors, and drive corrective action plans when necessary.
- Education & Feedback Loops: Translate QA audit findings into actionable insights. Provide structured feedback and target educational resources to internal CDI specialists and vendors to prevent recurring errors.
- Other duties as assigned
Minimum Qualifications:
- Bachelor's Degree in health care management, nursing or related field or an Associate Degree with relevant experience in CDI, coding, coding management, or HCC Risk Adjustment required.
- Minimum of 4 years of HCC coding experience with 2 years specifically focused on coding quality assurance, auditing, or compliance monitoring.
- Active professional credentials from AAPC and/or AHIMA required (such as CRC, CCS, CPC, or CPMA).
- Deep mastery of ICD-10-CM coding, CMS Risk Adjustment guidelines, RADV audit rules, and clinical documentation requirements.
Preferred KSA's:
- CRC (Certified Risk Adjustment Coder)
- Experience working within Value-Based Care (VBC) models, ACOs, or Advantage plans.
- Prior experience managing small teams or leading vendor oversight programs.
- Exceptional leadership, communication, and organizational skills.
- Proficiency with EHR systems and encoder software
Who We Are:
Aledade PBC, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade PBC, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
At Aledade PBC, we don't just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
We may use automated tools, including artificial intelligence (AI), to help organize and evaluate application materials. These tools support our recruiters and hiring managers by helping manage large applicant pools. Human judgment plays an essential role in our hiring process, including in the oversight and use of any automated tools. If you would like more information about our screening and hiring process, please contact us. Our Commitment to Authenticity. We use Endorsed, a fraud detection tool, to validate the authenticity of applications and protect against identity fraud. This ensures we are connecting with real people and allows us to prioritize genuine candidates. When you apply to a job on this site, the personal data contained in your application will be collected by Aledade PBC using Lever, a cloud services provider located in the United States. Lever is engaged by Aledade PBC to help manage its recruitment and hiring processes. For more information about how your personal data will be processed by Aledade PBC and any rights you may have, please review Aledade PBC's Candidate Privacy Notice. By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants If you have any questions about our privacy practices, please contact [email protected].
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