Coding Compliance Specialist

Job Summary

A company is looking for a Coding Compliance Specialist responsible for overseeing and evaluating Risk Adjustment Data Validation medical record review work.

Key Responsibilities

• Ensure adherence to CMS RADV payment and risk adjustment policies
• Provide expert guidance on coding and documentation standards
• Review escalated Medicare RADV medical record cases and resolve complex issues

Required Qualifications

• RADV experience required
• Minimum 5 years of supervisory experience in medical record review, preferably RADV
• Proven expertise in reviewing escalated Medicare RADV medical record cases
• Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA)
• Advanced knowledge of coding systems and compliance regulations