Senior Risk Adjustment Auditor - RADV & QA Lead

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

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k)

Time off

Job summary

The Senior Risk Adjustment Auditor at Sanford Health must have broad clinical knowledge and a strong understanding of RADV audits and HCC coding. You will review charts, claims, and enrollment data to ensure accuracy of risk adjustment submissions to CMS and DHS, and mentor staff on coding quality and regulatory readiness.

This remote WI role involves leading educational initiatives, working independently with limited supervision, and collaborating with data teams to support ACA/Medicare

Qualifications

• Minimum 5 years HCC coding and auditing for risk adjustment.
• Experience with RADV protocols and risk adjustment procedures.
• Basic familiarity with Microsoft Excel; Epic or similar EMR preferred.

Responsibilities

• Review charts, claims, and enrollment data to support coding accuracy.
• Identify quality issues and perform root cause analysis.
• Educate providers and staff on coding guidelines and CMS requirements.
• Support regulatory readiness activities and RADV audits.

Skills

HCC coding

Auditing

RADV protocols

CMS HCC model

Data analysis

Education

Associate degree

Bachelor’s preferred

Tools

Microsoft Excel

Epic EMR

Job description

The Senior Risk Adjustment Auditor at Sanford Health must have broad clinical knowledge and a strong understanding of RADV audits and HCC coding. You will review charts, claims, and enrollment data to ensure accuracy of risk adjustment submissions to CMS and DHS, and mentor staff on coding quality and regulatory readiness.

This remote WI role involves leading educational initiatives, working independently with limited supervision, and collaborating with data teams to support ACA/Medicare