Lead Risk Adjustment QA & Audit Operations

Univera Healthcare; United States; Hybrid; USD 72,000 - 129,000; Full time

Benefits offered by this job

Remote work possible (case-by-case)

Job summary

Univera Healthcare is seeking a Supervisor, Risk Adjustment Quality Assurance and Auditing to lead the QA audit team, ensuring accurate coding and regulatory compliance across CMS RADV and HRADV programs.

The role provides training, performance management, and process improvements to drive efficiency and audit quality while partnering with leadership to meet internal and external audit requirements.

Qualifications

• Five years ICD-10-CM and HCC coding experience required.
• Experience with CMS and HHS RADV and HRADV audits.
• Prior supervision or project management experience.
• CPC and CRC certifications required; other certifications preferred.

Responsibilities

• Provide strategic oversight to the Risk Adjustment QA Audit team.
• Direct day-to-day operations and ensure regulatory compliance.
• Oversee RADV/HRADV audits and monthly quality audits.
• Coach and train staff; conduct performance evaluations.
• Develop corrective action plans and training materials.
• Ensure audits follow CMS guidelines and ICD-10-CM standards.

Skills

ICD-10-CM coding

HCC coding

CMS RADV/HRADV audits

Supervisory experience

Project management

Healthcare terminology

Education

Associate’s degree in healthcare

CPC and CRC certifications

CDEO preferred

Job description

Univera Healthcare is seeking a Supervisor, Risk Adjustment Quality Assurance and Auditing to lead the QA audit team, ensuring accurate coding and regulatory compliance across CMS RADV and HRADV programs.

The role provides training, performance management, and process improvements to drive efficiency and audit quality while partnering with leadership to meet internal and external audit requirements.