ZipRecruiter

Log In

1

Radv Coding Jobs (NOW HIRING)

EmblemHealth

Lead Audit Specialist - Remote

New York, NY · On-site +1

$77K - $149K/yr

Develop and refine RADV audit strategies, including improvements in medical record retrieval processes and reducing coding errors; manage efforts to enhance RADV audit coordination workflows.

Harris Health System

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 ...

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike. * Own encounter data ...

ICONMA

Professional Coder I

Newark, NJ · On-site

... coding guidelines and risk adjustment model regulations. * This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual ...

next page

Showing results 1-20

All JobsRadv Coding Jobs

Radv Coding information

See salary details

$29K

$57.4K

$80.5K

How much do radv coding jobs pay per year?

As of Jul 2, 2026, the average yearly pay for radv coding in the United States is $57,391.00, according to ZipRecruiter salary data. Most workers in this role earn between $46,000.00 and $66,500.00 per year, depending on experience, location, and employer.

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.

More about Radv Coding jobs
What cities are hiring for Radv Coding jobs? Cities with the most Radv Coding job openings:
What states have the most Radv Coding jobs? States with the most job openings for Radv Coding jobs include:
What job categories do people searching Radv Coding jobs look for? The top searched job categories for Radv Coding jobs are:
Radv Coding jobs near you
Infographic showing various Radv Coding job openings in the United States as of June 2026, with employment types broken down into 88% Full Time, 9% Part Time, and 3% Contract. Highlights an 81% Physical, 3% Hybrid, and 16% Remote job distribution, with an average salary of $57,391 per year, or $27.6 per hour.
Lead Audit Specialist - Remote

Lead Audit Specialist - Remote

EmblemHealth

New York, NY • On-site, Remote

$77K - $149K/yr

Full-time

Posted 26 days ago

Job description

Summary of Job
Lead and coordinate all phases of external regulatory audits across Medicare Advantage, Medicare Part D, Medicaid Managed Care (including Child Health Plus), and Commercial (on and off exchange) plan products, ensuring timely and accurate data submissions. Plan, manage, and provide oversight for RADV audits, including data analysis to identify required medical records, vendor oversight, project management, and submission of medical records, supporting documents, and data files. Lead and coordinate Part C & D Data Validation audits, including stakeholder communication, data collection and quality review, aggregation, and submission of supporting documentation. Provide operational and regulatory guidance to prepare for audits, minimize audit risk, and protect the organization from adverse financial impacts related to risk adjustment. Manage vendor relationships and contracts to ensure audit vendors follow best practices and support accurate, compliant risk adjustment and enrollment revenue. Collaborate with regulators, internal SMEs, and cross-functional departments to gather, organize, and deliver required documentation to auditors. Coordinate organizational responses to audit findings and facilitate timely remediation or corrective action as needed. Ensure overall audit success by delivering required information accurately and on schedule with minimum disruption to operational areas.
Responsibilities
  • Manage the coordination of HHS ACA RADV IVA Audits, CMS MA contract level RADV Audits, and Commercial on/off exchange products, including HCC validation, Demographic and Enrollment (D&E) validation and Pharmacy Claims ("RXC") validation for all EH and CCI HIOS IDs, etc.
  • Manage external Medicare, Medicaid (including Child Health Plus) and commercial product-related audit efforts, including audits from CMS and its audit contractors/consultants, HHS OIG, NYS DOH, NYS OMIG, NYS Dept of Finance and NYS Office of the State Comptroller.
  • Coordinate the efforts of multiple departments that support our response to these audits.
  • Lead the full audit lifecycle, including announcements, entrance/exit conferences, onsite activities, documentation, delivery of findings, corrective action plan (CAP) collection and tracking, and submission of required monitoring reports to regulatory agencies.
  • Coordinate and organize audit activities across operational areas; serve as the primary liaison to external auditors, including managing onsite visits, documenting meeting minutes, and maintaining the electronic audit archive.
  • Manage end-to-end audit documentation requests, including gathering data, policies, sample materials, and other evidence from internal departments; ensure timely, secure delivery to auditors and maintain a complete archive of deliverables and communications.
  • Ensure regulatory audits for Medicare, Medicaid, and Commercial products are conducted efficiently with minimal business disruption; recommend and implement process improvements to streamline audit and compliance operations.
  • Provide routine audit monitoring reports to CMS and internal leadership as necessary; conduct trend analysis, offer audit planning recommendations, and develop processes to strengthen regulatory compliance and audit readiness.
  • Support and coordinate CMS Part C & Part D IPM, CMS Contract-Level RADV, and HHS OIG RADV audits, including managing medical record retrieval, validating claims/encounter/provider data, and tracking all RADV deliverables.
  • Develop and refine RADV audit strategies, including improvements in medical record retrieval processes and reducing coding errors; manage efforts to enhance RADV audit coordination workflows.
  • Collaborate with internal teams (including, but not limited to Enrollment, Provider Operations, Provider Relations, Network Management, Relationship Managers) to ensure providers, facilities, delegates, and vendors supply required information for the annual IVA audit; implement HHS mandated IVA process changes.
  • Work with the Medicare Compliance and External Audit Leader on process improvement initiatives.
  • Compile data and information to support monitoring reports and reporting to Senior Management as required.
  • Support other Compliance Department activities as directed, assigned, or required.
  • Support organizational initiatives and projects.

Qualifications
  • Bachelor's Degree.
  • 5 - 8+ years' relevant, professional work experience.
  • Experience in healthcare industry - performing/participating in audits (Required)
  • Extensive knowledge of Medicare Advantage and Medicare Prescription Drug Programs; HHS ACA RADV IVA audits; CMS Medicare Advantage contract-level audits; and Commercial on/off-exchange products, including HCC validation, Demographic & Enrollment (D&E) validation, and Pharmacy Claims (RXC) validation across all applicable HIOS IDs (Required)
  • Experience managing external audit activities for Medicare, Medicaid (including Child Health Plus), and commercial product lines, including audits conducted by CMS and its contractors, HHS OIG, NYS DOH, NYS OMIG, NYS Department of Financial Services, and the NYS Office of the State Comptroller; familiarity with regulators' audit processes and requirements (Required)
  • Working knowledge of health insurance operations; understanding of Commercial health insurance, enrollment, and Individual and Small Group coverage, etc. (Required)
  • Additional experience/specialized training may be considered in lieu of educational requirement (Required)
  • Proficiency in the use of Microsoft Office - Word, Excel, Access, PowerPoint, Outlook, Teams, etc. (Required)
  • Ability to organize, prioritize, and successfully manage multiple tasks/projects with simultaneous competing deadlines (Required)
  • Strong analytical and problem-solving skills; and outstanding attention to details (Required)
  • Must be a leader and consensus-builder, able to successfully negotiate with Department heads for the timely delivery of audit data and documents (Required)
  • Must be a team player willing to assist, and correctly advise, operational areas on successful completion of audits, submission of audit deliverables and compliance with regulations (Required)
  • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
  • Ability to arrange work schedule to meet deadlines from multiple sources and engage staff throughout EmblemHealth to assist in the completion of duties and to travel to all EmblemHealth facilities as needed (Required)
  • Ability to advise Senior Management on regulatory reporting and audit trends and tactics, as well as EmblemHealth's audit vulnerabilities and risks.

Apply