Senior Risk Adjustment Auditor - RADV & HCC Expert (Remote)

Good Samaritan Society; South Dakota; Hybrid; USD 43,000 - 68,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k) retirement plan

Work/life balance benefits

Generous time off package

Job summary

Sanford Health in remote SD is seeking a Senior Risk Adjustment Auditor with strong HCC coding and RADV experience. The role focuses on RADV audits, QA oversight, and training to improve coding accuracy across providers and clinical staff.

Will work independently with autonomy, collaborating with data analysts on relevant operations and ensuring compliance with CMS HCC models and audit rules. Requires RN license or multistate licensure where applicable.

Qualifications

• Minimum of 5 years HCC coding and auditing for Risk Adjustment.
• Intermediate understanding of RADV protocols and procedures; retrospective and prospective risk adjustment.
• Basic familiarity with Microsoft Excel.
• RN license preferred; holds or willing to obtain competencies and certifications.
• CRC or CPC certification or relevant equivalent is required.

Responsibilities

• Support RADV audits and risk adjustment data validation activities.
• Provide quality assurance oversight and provider/staff education.
• Develop and deliver educational materials to improve coding accuracy.

Skills

HCC coding

RADV

Epic

CMS HCC

Audit

Education

Associate degree

Bachelor’s preferred

Tools

Microsoft Excel

Epic

Job description

Sanford Health in remote SD is seeking a Senior Risk Adjustment Auditor with strong HCC coding and RADV experience. The role focuses on RADV audits, QA oversight, and training to improve coding accuracy across providers and clinical staff.

Will work independently with autonomy, collaborating with data analysts on relevant operations and ensuring compliance with CMS HCC models and audit rules. Requires RN license or multistate licensure where applicable.