Manager, Coding Quality & RADV Audits

Overview

We are representing a confidential healthcare technology organization seeking a Manager, Coding Quality & RADV Audits to lead strategic oversight of CMS audit activities supporting Medicare Advantage and Commercial lines of business. This remote position offers the opportunity to provide executive-level leadership for risk adjustment data validation (RADV) audits while driving compliance, operational excellence, and continuous improvement across coding quality functions.

Our talent team at Get A Job.ai is partnering with this client to identify an experienced leader who can translate regulatory requirements into actionable operational objectives while fostering collaboration across clinical, compliance, and technology teams.

Responsibilities

• Lead strategic planning, coordination, and execution of CMS-mandated RADV audits across Medicare Advantage and Commercial business lines
• Develop and implement audit strategies, workflows, processes, and performance objectives to ensure regulatory compliance
• Direct departmental operations including planning, problem-solving, staff development, performance management, and organizational communication
• Establish priorities and balance workloads to maximize productivity, quality, efficiency, and resource utilization
• Translate business and regulatory requirements into measurable operational outcomes
• Identify and lead process improvement initiatives to implement sustainable operational solutions
• Provide executive-level leadership for strategic initiatives and regulatory activities
• Monitor departmental performance, identify trends and risks, and implement corrective actions
• Foster partnerships across business, clinical, compliance, technology, and operational teams
• Ensure alignment with CMS regulations, company policies, contractual requirements, and industry standards
• Directly supervise exempt and non-exempt employees including interviewing, hiring, onboarding, training, performance evaluation, and coaching
• Develop and interpret policies and procedures, providing feedback to senior management regarding coding quality and supporting technology platforms

What We're Looking For

Education & Certification:

• Bachelor's degree preferred; clinical license with extensive relevant experience considered in lieu of degree
• Active coding certification required: CPC, COC, or CRC from AAPC, or CCS or CCS-P from AHIMA
• Commitment to continuous professional development

Experience:

• Minimum 7 years of experience in risk adjustment programs
• Minimum 3 years of management experience in a medical coding quality assurance environment with demonstrated technical expertise
• Experience within the healthcare payer industry including health plans, third-party administrators, benefits consulting, or healthcare technology organizations
• Proven experience leading complex, enterprise-level projects, programs, or regulatory initiatives
• Experience with Medicare Advantage, Commercial health plans, risk adjustment, RADV audits, IVA, or related CMS compliance activities strongly preferred
• Demonstrated knowledge and practical experience with CMS regulations and requirements

Skills & Competencies:

• Strong knowledge of healthcare payer operations, industry practices, and regulatory requirements
• Proven ability to manage competing priorities while understanding downstream impacts of timeline and resource changes
• Demonstrated ability to lead large-scale initiatives and deliver complex projects within enterprise environments
• Strong capability in defining, prioritizing, and communicating business requirements
• Excellent organizational, analytical, written, verbal, and presentation skills
• Proven ability to facilitate collaboration and achieve results within a matrixed organizational environment
• Strong relationship-building and stakeholder-management skills with ability to partner effectively with senior leaders
• Demonstrated leadership, coaching, team building, and employee development capabilities
• Ability to establish effective workflows, manage multiple projects simultaneously, and consistently meet deadlines
• Strong problem-solving and decision-making skills with ability to develop practical, sustainable solutions
• Proficiency with Microsoft Word, Excel, and PowerPoint required
• Experience with Microsoft Project preferred
• Experience with JIRA or similar project-management tools preferred

Work Environment:

• Remote position, United States-based
• Full-time, permanent, exempt position
• Ability to work across multiple time zones
• May require occasional travel

How We Work With You

Interested candidates should apply directly through Get A Job.ai. Our recruiting team will conduct an initial screening to understand your background, experience, and career goals. Qualified candidates will then be submitted to our client for consideration. Please do not attempt to contact the client directly, as all applications must be processed through our recruiting team to be considered.

We coordinate the entire interview process and provide guidance at each stage to ensure a smooth candidate experience.

Pay

Compensation details will be discussed during the screening process with our recruiting team.

Equal Employment Opportunity: Get A Job.ai is committed to fair and equitable recruiting practices. We welcome applications from all qualified candidates regardless of race, ethnicity, gender, age, veteran status, disability, or other protected characteristics.