Director of RADV Audit Operations

A company is looking for a Director of RADV Audit Operations.

Key Responsibilities

Manage all phases of the RADV audit process, including data validation and medical record retrieval

Develop and implement strategies to enhance coding accuracy and documentation integrity

Collaborate with various departments to ensure accurate data submission and effective audit execution

Required Qualifications

5+ years of experience in risk adjustment and managing CMS or regulatory audits

Bachelor's degree in a relevant field

3+ years of leadership experience in health plan medical coding processes preferred

Professional certifications such as CPC, CRC, or CCS are highly desirable

Deep knowledge of CMS-HCC Risk Adjustment model and ICD-10 coding guidelines is essential