Oversee RADV/HCC audits and documentation improvement strategies * Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements * Identify opportunities to ...
Oversee RADV/HCC audits and documentation improvement strategies * Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements * Identify opportunities to ...
Risk Adjustment Coder II
Houston, TX · On-site
$18 - $23.75/hr
... and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data ...
Risk Adjustment Coder II
Houston, TX · On-site
$18 - $23.75/hr
... and internal coding policies for the following programs: including, but not limited to, Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and attending REGTAP calls. Stay current with coding standards, risk adjustment methodologies, and CMS ...
Risk Adjustment Coder II
Houston, TX · On-site
$27.69 - $34.61/hr
Ensure coding compliance by following the Official Coding Guidelines, HHS-RADV Protocols, and attending REGTAP calls. Stay current with coding standards, risk adjustment methodologies, and CMS ...
Hierarchical Condition Category (HCC) Coding Specialist
Austin, TX · 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
Austin, TX · 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.
Auditor, Risk Adjustment
Dallas, TX · 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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Auditor, Risk Adjustment
Dallas, TX · 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 ...
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?
| 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 Texas? For Radv Coding jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Radv Coding jobs in Texas look for? The top searched job categories for Radv Coding jobs in Texas are:
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Full-time
Posted 16 days ago
Job description
Description:
VMG Health supports a nationwide network of clients with over 70,000 engagements, exclusively in the healthcare industry. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. VMG Health provides a solutions-oriented approach to client needs through our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients’ valuation, strategic, and compliance needs.
Requirements:We are seeking an experienced Director to support the continued growth of our Coding, Audit, Compliance, and Revenue Cycle Management (RCM) consulting practice. This role will provide strategic leadership across client engagements, with a particular focus on coding compliance, revenue cycle operations, and risk adjustment (RADV/HCC).
The Director will play a key role in designing and delivering provider-focused education and training programs across multiple specialties, supporting documentation improvement, coding accuracy, and overall compliance.
This individual will lead complex engagements, guide high-performing teams, and partner with clients to develop actionable, compliant, and operationally effective solutions. This is a highly visible, client-facing role with opportunities to contribute to service line innovation and business development.
Key Responsibilities
Client Engagement & Leadership
- Provide strategic oversight for coding, audit, compliance, and revenue cycle engagements
- Serve as a trusted advisor to clients, delivering clear, actionable recommendations
- Ensure delivery of accurate, high-quality, and audit-defensible work products
- Lead executive-level presentations and client discussions
Revenue Cycle & Risk Adjustment Expertise
- Lead and advise on RCM initiatives, including coding, billing, audit, and revenue integrity
- Oversee RADV/HCC audits and documentation improvement strategies
- Evaluate provider documentation and coding accuracy to ensure compliance with CMS and payer requirements
- Identify opportunities to improve reimbursement, risk capture, and operational performance
Team Leadership & Development
- Mentor and develop Managers, Auditors, and consulting staff
- Provide guidance on engagement execution, quality standards, and client communication
- Foster a collaborative, high-performing team environment
Business Development
- Develop and maintain client relationships to support growth
- Identify and pursue new business opportunities
- Participate in proposals, presentations, and industry events
- Contribute to thought leadership, including publications and speaking engagements
Qualifications
Experience
- 8+ years of healthcare industry experience
- Proven experience in Revenue Cycle Management (RCM) and healthcare operations
- Demonstrated expertise in HCC/risk adjustment coding and documentation
Technical Expertise
- Strong knowledge of:
- ICD-10-CM, CPT®, and HCPCS coding
- E/M documentation guidelines
- CMS regulations and payer requirements
- Revenue cycle processes (coding, billing, denials, reconciliation)
Credentials
- CPC, CPMA, CRC required
- Bachelor’s degree preferred
Skills & Competencies
- Strong analytical and problem-solving abilities
- Excellent written and verbal communication skills
- Executive presence and client-facing experience
- Ability to manage multiple complex projects simultaneously
- Detail-oriented with a strong focus on quality and compliance
About VMG Health
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
51 - 200 Employees
Headquarters location
Dallas, TX, US
Year founded
1995