Manager, Coding Quality – RADV Audits

Jobtailor; Deutschland; Hybrid; EUR 120.000 - 180.000; Vollzeit

Zusammenfassung

Jobtailor is seeking an experienced senior leader to oversee CMS-mandated RADV audits across Medicare Advantage and Commercial lines. The role entails developing audit strategies, guiding cross-functional teams, and ensuring adherence to CMS regulations and contractual requirements.

You will direct departmental operations, manage staffing and performance, and drive process improvements in a regulated healthcare payer environment. Hybrid/remote work in Germany is supported.

Qualifikationen

• Bachelor’s degree preferred; candidates with a clinical license and extensive relevant experience may be considered in lieu of degree.

Aufgaben

• Provide strategic leadership, planning, project coordination, and operational oversight for CMS-mandated RADV audits across Medicare Advantage and Commercial lines of business.

Kenntnisse

Strategic Leadership

Staff Development

Cross-functional Collaboration

CMS Regulations

Project Management

Data Analysis

Quality Assurance

Risk Adjustment

Regulatory Initiatives

Microsoft Office

JIRA

Ausbildung

Bachelor's degree preferred

Clinical license acceptable in lieu of degree

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Project

JIRA

Jobbeschreibung

• Provide strategic leadership, planning, project coordination, and operational oversight for CMS-mandated RADV audits across Medicare Advantage and Commercial lines of business


• Develop and implement audit strategies, workflows, processes, and performance objectives


• Establish priorities and balance departmental workloads to maximize productivity, quality, efficiency, and resource utilization


• Direct departmental operations, including planning, problem-solving, staff development, performance management, and organizational communication


• Translate business and regulatory requirements into actionable objectives and measurable outcomes


• Identify process-improvement and operational-efficiency opportunities and implement sustainable solutions


• Provide executive-level and cross-functional leadership for strategic initiatives and regulatory activities


• Lead special projects, initiatives, and complex problem-resolution efforts


• Monitor departmental performance, identify trends and risks, and implement corrective actions


• Foster partnerships across business, clinical, compliance, technology, and operational teams


• Ensure departmental activities align with CMS regulations, company policies, contractual requirements, and industry standards


• Supervise exempt and non-exempt employees


• Interview, select, hire, onboard, and train employees


• Plan, assign, prioritize, and direct work


• Establish performance expectations and conduct performance evaluations


• Coach, develop, recognize, and counsel employees


• Support improved quality coding reporting


• Address employee concerns and resolve workplace issues


• Manage staffing levels, resource allocation, and departmental capacity


• Develop and interpret policies and procedures and recommend changes to senior management

Requirements

• Bachelor’s degree preferred; candidates with a clinical license and extensive relevant experience may be considered in lieu of degree


• Required coding certification: CPC, COC, or CRC from AAPC, or CCS or CCS-P from AHIMA


• Minimum of 7 years of experience in risk adjustment programs


• Minimum of 3 years of management experience in a medical coding quality assurance environment with demonstrated technical experience


• Experience within the healthcare payer industry, including health plans, third-party administrators, benefits consulting, or healthcare technology organizations


• Experience leading complex, enterprise-level projects, programs, or regulatory initiatives


• Knowledge and practical experience with CMS regulations and requirements


• Proficiency with Microsoft Word, Excel, and PowerPoint required


• Experience with Microsoft Project preferred


• Experience with JIRA or similar project-management tools preferred


• Ability to work across multiple time zones in a hybrid or remote work environment


• May be required to pass a pre-employment criminal background check


• Must meet physical demands including extended periods sitting and/or standing at a computer

Core Competencies

Demonstrates expertise in strategic leadership and operational oversight for CMS-mandated RADV audits, with a strong focus on developing audit strategies and ensuring compliance with regulatory requirements. Proven ability to manage departmental performance, foster cross-functional partnerships, and implement process improvements in the healthcare payer industry.

Highest-signal resume keywords

• Risk Adjustment Programs


• Management Experience in Medical Coding Quality Assurance


• CMS Regulations and Requirements


• Coding Certification (CPC, COC, CRC, CCS, CCS-P)


• Project Management Tools (JIRA, Microsoft Project)

ATS Optimization Keywords

Hard Skills

• Risk Adjustment Programs


• Management Experience in Medical Coding Quality Assurance


• CMS Regulations and Requirements


• Coding Certification (CPC, COC, CRC, CCS, CCS-P)


• Project Management


• Process Improvement


• Operational Efficiency


• Performance Management


• Data Analysis


• Quality Assurance

Soft Skills

• Strategic Leadership


• Problem-Solving


• Organizational Communication


• Employee Development


• Cross-Functional Collaboration

Certifications & Qualifications

• CPC


• COC


• CRC


• CCS


• CCS-P

Industry Keywords

• Healthcare Payer Industry


• Medicare Advantage


• Commercial Lines of Business


• Audit Strategies


• Regulatory Initiatives

Tools & Technologies

• Microsoft Word


• Microsoft Excel


• Microsoft PowerPoint


• Microsoft Project


• JIRA