Supervisor, Risk Adjustment Quality Assurance – Auditing

LTHC

. Provide strategic oversight, supervision, and support to Risk Adjustment Quality Assurance Auditors .

Posted 10/12/2026full-timeRochester • New York • United StatesMid-LevelSenior💰 $71,880 - $129,384 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive knowledge of ICD-10-CM coding, Risk Adjustment Data Validation Audits, and CMS guidelines while effectively managing and mentoring audit teams. Proven ability to enhance audit quality and productivity through strategic oversight and process improvements.

Highest-signal resume keywords

ICD-10-CM Coding ExperienceRisk Adjustment Data Validation AuditsCPC CertificationCRC CertificationHealthcare Industry Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Hierarchical Condition Category (HCC) CodingCoding Conventions and Payment RulesElectronic Medical Records (EMR) SystemsAudit Quality MonitoringCorrective Action Plans Development

Soft Skills

Strong Written Communication SkillsStrong Verbal Communication SkillsAnalytical SkillsOrganizational SkillsTime Management Skills

Certifications & Qualifications

CPC CertificationCRC CertificationCertified Documentation Expert Outpatient (CDEO)

Industry Keywords

CMS GuidelinesHHS Risk AdjustmentMedicaid CRG CodingHealth Care Reimbursement SystemsConfidential Health Information

About the role

Key responsibilities & impact

Provide strategic oversight, supervision, and support to Risk Adjustment Quality Assurance Auditors
Direct and coordinate day-to-day Risk Adjustment QA Audit team operations
Oversee monthly internal coding quality audits and federal/state risk adjustment data validation audits, including IPM, CON RADV, and HRADV
Document and define audit project expectations and parameters according to deadlines
Identify coding and audit education opportunities with the Risk Adjustment Coding Educator Manager and Training Lead
Coach, mentor, and train audit staff; conduct performance evaluations, goal setting, and quarterly check-ins
Ensure audits follow CMS guidelines, ICD-10-CM Official Coding Guidelines, risk adjustment coding standards, and organizational policies
Monitor audit quality, accuracy rates, and turnaround times; review complex cases as needed
Serve as a subject matter expert for Risk Adjustment Audit and Coding
Evaluate workloads and processes to maximize productivity and efficiency
Verify and report staff productivity and quality, assign audit due dates, set project expectations, and monitor completion
Develop corrective action plans and training materials; maintain quality and volume statistics
Function as a backup quality assurance auditor and execute audit projects
Recommend and implement process improvements to increase audit accuracy and productivity
Coordinate and perform RADV and other requested audits
Provide regular written and oral status reports and proactively identify risks
Report team and individual accomplishments, barriers, progress, and training needs to the Manager Risk Adjustment Coding and Auditing
Support Lifetime Healthcare Companies’ mission, values, Corporate Code of Conduct, and Lifetime Way values
Maintain member privacy and comply with legislative and regulatory mandates
Conduct regular staff meetings and distribute departmental and Ethics/Compliance information
Perform other functions as assigned by management

Requirements

What you’ll need

Five (5) years ICD-10-CM and Hierarchical Condition Category (HCC) coding experience required
Experience in CMS and HHS Risk Adjustment Data Validation Audits (RADV and HRADV)
Prior experience supervising or managing people and/or projects or indirectly leading teams
CPC and CRC certifications required
Other current coding certification (CPC-H, CPC-I, CCS, RHIA, or RHIT) preferred by AAPC or AHIMA
Associate’s degree in a health care related field preferred
Certified Documentation Expert Outpatient (CDEO) preferred
Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
Knowledge of healthcare industry
Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems
Comprehensive understanding of ICD-10 and other coding submitted to the Health Plan by contracted facilities and providers
Extensive knowledge of CMS and HHS HCC Risk Adjustment coding, Medicaid CRG coding, and data validation requirements
Strong written and verbal communication skills; strong analytical, organization and time management skills required
Ability to recognize and properly oversee confidential health information
Demonstrated ability to utilize a variety of Electronic Medical Records (EMR) systems
Demonstrated experience in project completion, educational program development, and/or group presentation
Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer
Ability to work in a home office for continuous periods of time for business continuity
Ability to travel across the Health Plan service region for meetings and/or trainings as needed
Repetitive motion required
Regular and reliable attendance is expected and required

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Opportunity for remote work, decided case-by-case
Home office work for business continuity
Equal Opportunity Employer