Lead Risk Adjustment QA & Auditing Supervisor

Excellus BCBS; United States; Remote; USD 72,000 - 129,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a Supervisor of Risk Adjustment Quality Assurance and Auditing to lead a team responsible for the accuracy, compliance, and quality of risk adjustment audits. The role focuses on training, performance management, and continuous process improvement across CMS, ICD-10-CM, and organizational guidelines.

The position requires 5+ years in ICD-10-CM/HCC coding with RADV/HRADV audit experience, CPC/CRC certifications, and strong leadership and communication skills.

Qualifications

• Five (5) years ICD-10-CM and HCC coding experience.
• Experience supervising or managing people and/or projects.
• Associate’s degree in a health care related field preferred.
• CPC and CRC certifications required; other certifications preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, and pharmacology.
• Knowledge of CMS and HHS RADV data validation requirements.
• Strong written and verbal communication skills; analytical and time management skills.

Responsibilities

• Provide strategic oversight and supervision to the Risk Adjustment QA Auditors, ensuring compliance with standards.
• Direct day-to-day operations of the QA Audit team with focus on coding accuracy and regulatory compliance.
• Oversee RADV and HRADV audits and other audits as requested, ensuring deadlines are met.
• Define audit project expectations and parameters in line with department and federal deadlines.
• Coach, mentor, and train audit staff; conduct performance evaluations and regular feedback.
• Ensure audits adhere to CMS guidelines, ICD-10-CM guidelines, and organizational policies.
• Monitor audit quality, accuracy, and turnaround times; review complex cases as needed.
• Act as SME for Risk Adjustment Audit and Coding, advising staff on best practices.
• Identify workload and process improvements to boost productivity and efficiency.

Skills

ICD-10-CM coding

HCC coding

Auditing & QA

Leadership & training

CMS & RADV/HRADV knowledge

Education

Associate’s degree in healthcare

CPC and CRC certifications

CDEO certification

CPC-H / CPC-I / CCS / RHIA / RHIT (preferred)

Tools

EMR systems

Job description

Excellus BCBS is seeking a Supervisor of Risk Adjustment Quality Assurance and Auditing to lead a team responsible for the accuracy, compliance, and quality of risk adjustment audits. The role focuses on training, performance management, and continuous process improvement across CMS, ICD-10-CM, and organizational guidelines.

The position requires 5+ years in ICD-10-CM/HCC coding with RADV/HRADV audit experience, CPC/CRC certifications, and strong leadership and communication skills.