Senior Medical Coding
2 weeks ago
Job Description: Senior Medical Coding & RADV Audit Specialist
Location:
[Remote]
Employment Type:
Contractor
About the Role
We are seeking a highly experienced, client-facing
Medical Coding Expert
with deep expertise in
RADV (Risk Adjustment Data Validation) audits
across multiple clients and health plans. The ideal candidate is comfortable engaging directly with clients, has extensive hands-on experience across all lines of business (Medicare Advantage, Medicaid, and ACA), and is proficient in using
coder workbench platforms
.
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.
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