Radv Validation Jobs (NOW HIRING)

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact—whether we’re supporting data-driven decisions, modernizing systems or safeguarding critical programs.

We are seeking an experienced and detail-oriented Senior Medical Coder to support our Medicare Part C Risk Adjustment Data Validation (RADV) initiatives. The ideal candidate will have strong experience in ICD-9-CM/ICD-10-CM coding across various care settings, including inpatient, outpatient, and physician office encounters. The candidate will perform diagnosis coding, support intake reviews, conduct appeal responses, and contribute to quality assurance efforts.
Responsibilities:

• Perform diagnosis coding of inpatient, outpatient, and physician office medical records per Risk Adjustment/Medicare Part C guidelines.
• Perform intake validity checks on each medical record submitted to ensure the submitted medical record documentation is from an acceptable physician specialty type, relevant dates of service for the specific Part C audit, include an acceptable physician/practitioner signature, and review submitted Attestation, is submitted. Record all process information in system in accordance with contract and organizational guidelines and processes.
• Perform Medical Record Dispute and Appeal reviews including technical writing per Part C guidelines.
• Provide Appeals support as RADV Subject Matter Expert at CMS request
• Participate and contribute to QA Panel discussions for medical record review intake/coding and appeals, as needed.
• Interact with the physician reviewer(s) as required.
• Answer questions from coders through the escalation process.
• Accurately enter data into encoder, system, and other as required software using a personal computer, keyboard and/or mouse.
• Follow all established processes and procedures.
• Report problems to Project Lead, Project Manager, or Project Director with regard to unique record or process issues.
• Maintain security and confidentiality of medical records and Protected Health Information (PHI).
• Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the company.
• Consistently meet attendance standards established by the company.
• Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
• Assist Project Manager with development of training materials.
• Assist with training and feedback of coders.
• Perform other duties and projects assigned.

• A minimum of five (5) years of experience in coding general acute hospital (inpatient and outpatient ) and/or multi-specialty physician office medical records by applying ICD-9-CM/ICD-10-CM coding guidelines.
• Must be a certified coder who is credentialed by a recognized credentialing institution (AAPC, AHIMA). Acceptable certifications: CPC, CCS, RHIA, RHIT
• CRC certification is a plus
• Experience in leading and/or supervising personnel in abstracting and ICD-9/ICD-10 coding preferred.
• Experience in Risk Adjustment Data Validation or CMS-HCC audits preferred
• Experience in performing medical record coding audits including complex medical record abstraction.
• Ability to work independently and maintain an elevated level of concentration.
• Capable of consistency, speed, and accuracy of task.
• Ability to read, analyze, and interpret physician documentation.
• Ability to communicate clearly and professionally with all levels of the organization, both written and verbal.
• Ability to work well in a team environment, to collaborate with others, and interface with team members internal and external to the organization.
• Must be proficient in Microsoft Office Suite.
• Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment.
• Ability to maintain a high level of confidentiality and integrity.

EEO Employer:

RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.

The annual salary range for this position is $60,000.00 to $80,000.00. Actual compensation will depend on a range of factors, including but not limited to the individual’s skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here