Auditor, Risk Adjustment Data Validation

University Health; San Antonio (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

University Health in San Antonio, TX seeks a RADV Auditor to validate ICD-10-CM coding accuracy and support CMS/RADV compliance. You will analyze data, prepare reports, and collaborate with providers to improve HCC ratios and risk adjustment initiatives.

The role emphasizes cross-functional teamwork, data integrity, and the development of procedures to monitor and reconcile data for accuracy.

Qualifications

• Bachelor’s degree required.
• Willingness to obtain coding certification within 6–12 months.
• 1–2 years of healthcare experience; coding experience preferred.
• Proficiency in ICD-10-CM coding principles.

Responsibilities

• Audit medical records to validate ICD-10-CM coding accuracy and CMS/RADV guidelines.
• Analyze data and prepare customized reports to drive improvements.
• Collaborate with providers and internal teams on HCC ratio goals.
• Develop procedures for monitoring, validating, and reconciling data for accuracy.
• Support compliance, quality assurance and risk mitigation strategies.

Skills

Analytical skills

Problem-solving

Communication

Organization

Education

Bachelor’s degree

Tools

EHR systems

Health information systems

Claims data analysis

Job description

POSITION SUMMARY/RESPONSIBILITIESThe Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-CM coding accuracy and ensure compliance with Centers for Medicare and Medicaid (CMS) and RADV guidelines. This role focuses on performing detailed audits, analyzing data, and collaborating with providers and internal teams to support Hierarchical Condition Categories (HCC) ratio goals and risk adjustment improvement initiatives. The auditor prepares customized reports based on data analysis and provides actionable recommendations to enhance operational and clinical performance. Additionally, the position assists in managing data collection processes and develops procedures for monitoring, validating, and reconciling data for accuracy. Working closely with cross-functional teams, the auditor supports compliance, quality assurance, and risk mitigation strategies while contributing to the development of tools and processes to improve coding accuracy and audit efficiency.EDUCATION/EXPERIENCEBachelor’s degree required. Coding certification (such as CPC, CRC, or CCS) is preferred, or candidates must demonstrate a willingness to obtain certification within 6–12 months of hire. Applicants should have 1–2 years of healthcare experience; prior coding experience is preferred. Strong analytical and problem-solving skills, coupled with attention to detail, are essential. Candidates must possess the ability to learn and apply ICD-10-CM coding principles, exhibit excellent communication and organizational skills. Proficiency in health information systems, electronic health records (EHRs), HEDIS, RADV, and claims data analysis is a plus.LICENSURE/CERTIFICATIONCoding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Risk Adjustment Coder-CRC)Location: University Health · Quality ManagementSchedule: Full Time, Day Shift, 40