Risk Adjustment QA & Auditing Lead

Capital District Physicians Health Plan, Inc.; City of Rochester (NY); Remote; USD 72,000 - 129,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Job summary

Univera Healthcare is seeking a Supervisor of Risk Adjustment Quality Assurance and Auditing to oversee a team of QA auditors, ensuring accuracy and regulatory compliance in ICD-10-CM coding and RADV/HRADV audits. The role provides leadership, coaching, and continuous improvement initiatives across CMS guidelines and internal standards.

The position partners with leadership on strategy, supports education for staff, and manages performance while maintaining member privacy and efficiency.

Qualifications

• Five years ICD-10-CM and HCC coding experience; RADV/HRADV audits.
• Supervisory/management experience on staff or projects.
• CPC and CRC certifications are required.
• Other coding certifications (CPC-H, CPC-I, CCS, RHIA or RHIT) preferred.
• Advanced knowledge of medical terminology, anatomy, pharmacology.
• Strong CMS and HHS HCC RADV/data validation knowledge.

Responsibilities

• Oversee day-to-day operations of Risk Adjustment QA Audit team.
• Ensure audits meet CMS ICD-10-CM guidelines and organizational policies.
• Provide coaching, training, and performance feedback to staff.
• Monitor quality, accuracy, and turnaround times of audits.
• Lead educational initiatives and process improvements for auditing teams.
• Prepare status reports and coordinate with leadership on audit results.

Skills

ICD-10-CM & HCC coding

CMS/HHS RADV & HRADV

Supervising people/projects

EMR systems

Communication skills

Project planning

Education

CPC and CRC certifications

Associate degree in healthcare

Other coding certifications (CPC-H/CPC-I/CCS/RHIA/RHIT) preferred

Tools

EMR systems

Job description

Univera Healthcare is seeking a Supervisor of Risk Adjustment Quality Assurance and Auditing to oversee a team of QA auditors, ensuring accuracy and regulatory compliance in ICD-10-CM coding and RADV/HRADV audits. The role provides leadership, coaching, and continuous improvement initiatives across CMS guidelines and internal standards.

The position partners with leadership on strategy, supports education for staff, and manages performance while maintaining member privacy and efficiency.