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Radv Coding Jobs in Georgia (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · 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 ...

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Radv Coding information

What are the key skills and qualifications needed to thrive as a RADV Coder, and why are they important?

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 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 are some common challenges faced by a RADV Coding professional, and how can they be effectively 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?

AspectRadv CodingMedical Billing Specialist
CredentialsCertification (e.g., AAPC, AHIMA), coding credentialsBilling and coding certifications, but often less specialized
Work EnvironmentHospitals, clinics, outpatient facilitiesMedical offices, billing companies, healthcare providers
Industry UsageUsed for accurate coding for reimbursement and recordsHandles billing, claims submission, and payment processing
Search & Comparison IntentFocuses on coding accuracy and complianceFocuses 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:
Radv Coding jobs near you
Infographic showing various Radv Coding job openings in Georgia as of May 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution.
Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only

Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only

Pantar Solutions inc

Atlanta, GA • On-site

Contractor

Posted 5 days ago

Job description

We are an Information Technology and Business Consulting firm specializing in Project-based Solutions and Professional Staffing Services. Please have a look at below position which is with our Client and let me know your interest ASAP. I would really appreciate if you could send me your MOST RECENT UPDATED RESUME: 

Title: Business Analyst – Risk Adjustment (Payor)

Location: Richmond or Atlanta  – Hybrid role

Long Term Contract || 1099 only || Need USC or GC only

Need strong Business Analyst – Risk Adjustment (Payor) with  risk adjustment analytics in a healthcare payer environment (Medicare Advantage, ACA (HIX/Exchange), or Medicaid), SQL, Excel, data visualization tools (Tableau/Power BI/SAS), healthcare data formats (claims, encounters, EMR, lab, and eligibility), regulatory processes (CMS, HHS, EDGE 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. Profiles

Job Summary:Client is seeking a highly analytical and motivated Business Analyst – Risk Adjustment to support risk adjustment operations and data analytics initiatives. This role is critical in helping ensure accurate and compliant capture of risk adjustment data for government-sponsored programs such as Medicare Advantage and ACA (HIX/Exchange). The candidate will play a key role in translating business needs into technical solutions, driving insights, and enabling optimized risk scoring strategies.
Key Responsibilities:

  • Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify trends, data quality issues, and improvement opportunities.

  • Collaborate with stakeholders across actuarial, clinical coding, IT, and compliance teams to support risk score accuracy.

  • Translate regulatory and business requirements into user stories or functional specifications for data/reporting solutions.

  • Support CMS/HHS risk adjustment submission processes including EDGE server management and encounter reconciliation.

  • Assist in development and enhancement of dashboards/reports for risk score monitoring, suspecting models, and provider performance.

  • Monitor and interpret changes in CMS/HHS risk adjustment guidelines and apply to internal business processes.

  • Participate in audit support (e.g., RADV, IVA) and validation of risk adjustment data submissions.

  • Act as liaison between technical teams and business stakeholders to ensure delivery of actionable and scalable solutions.

Qualifications:

  • Bachelor's degree in Healthcare Administration, Business, Analytics, or related field (Master’s preferred).

  • 8+ years of experience in risk adjustment analytics in a healthcare payer environment (Medicare Advantage, Medicaid, or ACA).

  • Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies.

  • Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.

  • Proficiency in SQL and Excel; experience with BI tools like Power BI, Tableau, or SAS preferred.

  • Familiarity with regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits).

Preferred Skills:

  • Knowledge of data and reporting tools, including Cognos or Watson Health platforms.

  • Experience in Agile environments; ability to write and manage JIRA user stories and tasks.

  • Strong communication and stakeholder engagement skills across technical and business teams.

 
Thanks & Regards,
 
Babu