Additionally, the RADV Nurse will provide direction and support to provider Medical Coding Analysts and Community First cross-functional team members regarding Risk Adjustment issues. Creates ...
Additionally, the RADV Nurse will provide direction and support to provider Medical Coding Analysts and Community First cross-functional team members regarding Risk Adjustment issues. Creates ...
Risk Adjustment Coding Auditor
Prosper, TX · On-site
$25 - $28.50/hr
This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required skillset: MS Suite CPC certified CRC certified 5+ years of risk ...
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Risk Adjustment Coding Auditor
Prosper, TX · On-site
$25 - $28.50/hr
This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV's. Required skillset: MS Suite CPC certified CRC certified 5+ years of risk ...
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 ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · On-site
$22.10 - $38.25/hr
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · On-site
$22.10 - $38.25/hr
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · Remote
$22.10 - $38.25/hr
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
Auditor, Risk Adjustment Data Validation
San Antonio, TX · Remote
$22.10 - $38.25/hr
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
POSITION SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with ...
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 ...
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 ...
Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits Education Bachelor's degree in Health ...
Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits Education Bachelor's degree in Health ...
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 ...
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 ...
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 ...
Medical Records & Support Coordinator
San Antonio, TX · On-site
$16 - $20.75/hr
... coding/ACI as needed. The medical records and ACI Support coordinator is responsible for ... validation (RADV) audits conducted by Health Plan, CMS or within Health Texas Department.
Medical Records & Support Coordinator
San Antonio, TX · On-site
$16 - $20.75/hr
... coding/ACI as needed. The medical records and ACI Support coordinator is responsible for ... validation (RADV) audits conducted by Health Plan, CMS or within Health Texas Department.
Medical Records & Support Coordinator
San Antonio, TX · On-site
$16 - $20.75/hr
... coding/ACI as needed. The medical records and ACI Support coordinator is responsible for ... validation (RADV) audits conducted by Health Plan, CMS or within Health Texas Department.
New
Medical Records & Support Coordinator
San Antonio, TX · On-site
$16 - $20.75/hr
... coding/ACI as needed. The medical records and ACI Support coordinator is responsible for ... validation (RADV) audits conducted by Health Plan, CMS or within Health Texas Department.
New
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:
What cities in Texas are hiring for Radv Coding jobs? Cities in Texas with the most Radv Coding job openings:
RADV (Risk Adjustment Validation) Nurse- Quality Management
San Antonio, TX • On-site
Full-time
This job post has expired 1 day ago. Applications are no longer accepted.
Job description
POSITION SUMMARY/RESPONSIBILITIES
Manages, supervises, and assists Sr. Manager Clinical Process Improvement of Quality Management and Accreditation with oversight assigned staff to facilitate high-quality, cost-effective care for Community First membership. The RADV Nurse will enhance consistency and efficiency by collaborating with Providers to meet goals for Hierarchical Condition Categories (HCC) Ratio. Spearhead initiatives for Risk Adjustment improvement, develop recommendations for Risk Adjustment plans, and design tools and databases to gather relevant data for assigned provider groups. Works closely with various departmental teams and their leaders in a matrix structure. Additionally, the RADV Nurse will provide direction and support to provider Medical Coding Analysts and Community First cross-functional team members regarding Risk Adjustment issues. Creates customized reports based on analysis of data for dissemination and makes recommendations to improve the quality of operational/clinical performance and health outcomes. Provides ongoing management of data collection systems and the development of procedures for monitoring, validating, and reconciling data for accuracy. May serve as a leader/facilitator of process improvement efforts. Provides oversight of and performs functions of review, investigation and analysis of member level clinical care data and provider performance as it compares to standards of care.
EDUCATION/EXPERIENCE
Graduation from an accredited school of professional nursing is required. Bachelor's degree in nursing, clinical informatics, or other health care related field is preferred. Over five years of experience in the healthcare industry, including at least one year of ICD-10 coding. Familiarity with CMS HCC Model and Guidelines, as well as ICD-10 Guidelines, is essential. Experience in data analysis and preparation of QI or related reports is preferred. Excellent communication and interpersonal skills required. Quality Management certification such as CPHQ or CHCQM is preferred. Working knowledge of continuous process improvement principles and standard coding products is preferred. Proficiency in health information systems, electronic health records (EHRs), HEDIS, RADV, and claims data analysis is a plus.
LICENSURE/CERTIFICATION
- Current licensure as a Registered Nurse in the State of Texas is required.
- Coding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Coding Specialist - CCS)