Remote RADV & Coding Quality Manager

HealthEdge; United States; Remote; USD 108,000 - 120,000; Full time

Benefits offered by this job

Remote work

Job summary

HealthEdge seeks a Manager, Coding Quality and RADV Audits to lead CMS RADV audits for Medicare Advantage and Commercial lines while driving strategy and regulatory compliance.

You will shape audit workflows, align cross-functional teams, and set performance objectives. Strong leadership, payer-domain knowledge, and project management are essential for success in a remote US, full-time role with a competitive salary.

Qualifications

• Bachelor’s degree preferred; clinical license with experience considered in lieu of degree.
• Coding certification such as CPC/COC/CRC or CCS/CCS-P from AAPC/AHIMA.
• Minimum seven years in risk adjustment programs; three+ years in coding quality assurance leadership.

Responsibilities

• Provide strategic vision and leadership for CMS RADV audits across Medicare Advantage and Commercial lines.
• Lead audit strategies, workflows, and performance objectives for regulatory compliance.
• Balance workloads and optimize productivity, quality, and resource utilization.
• Direct departmental operations, staff development, performance management, and communication.
• Translate regulatory requirements into actionable objectives and measurable outcomes.
• Identify opportunities for process improvement and lead sustainable solutions.
• Provide executive-level leadership for strategic regulatory initiatives.
• Lead special projects and complex problem resolution.

Skills

CMS RADV audits

Leadership

Regulatory compliance

Cross-functional coordination

Stakeholder management

Project management

Communication

Microsoft Office

JIRA

Education

Bachelor's degree preferred

Clinical license as alternative

Coding certification (CPC/COC/CRC/CCS/CCS-P/ CCS)

Tools

JIRA

Microsoft Project

Microsoft Word

Microsoft Excel

PowerPoint

Job description

HealthEdge seeks a Manager, Coding Quality and RADV Audits to lead CMS RADV audits for Medicare Advantage and Commercial lines while driving strategy and regulatory compliance.

You will shape audit workflows, align cross-functional teams, and set performance objectives. Strong leadership, payer-domain knowledge, and project management are essential for success in a remote US, full-time role with a competitive salary.