Remote RADV Coding Quality Manager (CMS Audits)

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 108,000 - 120,000; Full time

Benefits offered by this job

Remote work

Competitive compensation

Job summary

HealthEdge Software, Inc. is seeking a Manager, Coding Quality and RADV Audits to lead CMS RADV audit programs across Medicare Advantage and Commercial lines. This role provides strategic direction, operational oversight, and ensures regulatory compliance.

You will develop audit strategies, manage staffing, and collaborate with business and technology teams to deliver accurate coding and reporting. Remote US-based, full-time position with opportunities to shape healthcare payer analytics.

Qualifications

• A bachelor’s degree is preferred; however, candidates with a clinical license and extensive relevant experience will be considered in lieu of degree
• Coding certification required: CPC, COC, CRC (AAPC) or CCS/CCS-P (AHIMA)
• Seven+ years in risk adjustment programs; three years in medical coding QA management

Responsibilities

• Provide strategic leadership for CMS RADV audits across Medicare Advantage and Commercial lines
• Lead development and implementation of audit strategies, workflows, and performance objectives
• Direct department operations and staff development with a focus on quality coding reporting
• Foster cross-functional partnerships to ensure regulatory compliance and operational goals
• Monitor performance, identify risks, and drive continual improvement initiatives

Skills

Leadership

Project management

Regulatory knowledge

Stakeholder management

Strategic thinking

Communication

Cross-functional collaboration

Problem solving

Education

Bachelor’s degree preferred

Clinical license considered

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

Tools

Microsoft Word

Excel

PowerPoint

Microsoft Project

JIRA

Job description

HealthEdge Software, Inc. is seeking a Manager, Coding Quality and RADV Audits to lead CMS RADV audit programs across Medicare Advantage and Commercial lines. This role provides strategic direction, operational oversight, and ensures regulatory compliance.

You will develop audit strategies, manage staffing, and collaborate with business and technology teams to deliver accurate coding and reporting. Remote US-based, full-time position with opportunities to shape healthcare payer analytics.