Senior Medical Coding & RADV Audit Specialist

Location:

Employment Type:

About the Role

Medical Coding Expert

This is a senior role that requires both technical coding proficiency and the ability to provide strategic guidance and audit support to our clients.

Key Responsibilities

• Lead and support 

  RADV audits

   across diverse client portfolios, ensuring compliance and accuracy in documentation.
• Serve as a 

  trusted client-facing coding expert

  , communicating audit findings, clarifications, and recommendations.
• Perform 

  medical chart reviews

   with accuracy and speed, ensuring proper HCC capture and alignment with CMS guidelines.
• Leverage 

  coder workbench tools

   to streamline coding workflows and improve efficiency.
• Work across 

  all lines of business (Medicare, Medicaid, ACA)

   with demonstrated adaptability to plan-specific requirements.
• Collaborate with risk adjustment, quality, and analytics teams to ensure coding practices align with organizational and regulatory standards.
• Stay current on 

  ICD-10-CM guidelines, HCC coding updates (V24–V28), CMS RADV protocols

  , and other compliance requirements.
• Support internal teams and clients during 

  audit preparation, submission, and response processes

  .
• Provide 

  training, mentoring, and guidance

   to junior coders as needed.

Required Qualifications

• 5–7+ years

   of hands-on medical coding experience, with a strong focus on 

  risk adjustment and RADV audits

  .
• Certified coder credentials (e.g., 

  CPC, CRC, CCS, CCS-P

  ) strongly preferred.
• Proven client-facing experience with 

  multiple health plans or audit engagements

  .
• Deep knowledge of 

  ICD-10-CM, HCC coding, and CMS risk adjustment guidelines

  .
• Proficiency with 

  coder workbench systems and EHR platforms

  .
• Demonstrated ability to code across 

  all LOBs (MA, Medicaid, ACA)

  .
• Strong attention to detail, compliance mindset, and ability to meet deadlines under pressure.
• Excellent communication and presentation skills for client interactions.

Preferred Skills

• Experience leading 

  RADV audit defense and appeals

  .
• Knowledge of 

  encounter data submission requirements

  .
• Familiarity with 

  provider education and documentation improvement strategies

  .
• Ability to work in a fast-paced, client-driven environment with minimal supervision.