Supervisor, Risk Adjustment Quality Assurance and Auditing

The Supervisor, Risk Adjustment Quality Assurance and Auditing, is responsible for oversight of the daily operations of the Risk Adjustment Quality Assurance Auditor team. This role ensures the accuracy, compliance, and quality of the risk adjustment coding and documentation audits in alignment with regulatory requirements and organizational policies. This position provides leadership, training, and performance management to audit staff while driving continuous improvement in audit processes, coding accuracy, and operational efficiencies.

The Supervisor partners with leadership on developing strategies to enhance efficiency and quality practices and to prioritize all internal, state, and federal government audits (CMS Improper Payment Measure (IPM), Contract‑level Risk Adjustment Data Validation (CON RADV), and Department of Health and Human Services (HRADV) and auditor workflow.

Provide strategic oversight, supervision, and support to a team of Risk Adjustment Quality Assurance Auditors, ensuring all audit activities strictly adhere to state, federal, and corporate standards. Direct and coordinate the day‑to‑day operations of the Risk Adjustment QA Audit team, ensuring coding accuracy, regulatory compliance, and consistent application of CMS, ICD‑10‑CM, and organizational guidelines. Oversee risk adjustment audit activity including monthly internal coding quality audits and all federal and state risk adjustment data validation audits including, but not limited to, Improper Payment Measure, Contract‑level RADV, Department of Health and Human Services RADV (HRADV).

Documents and defines audit project expectations and parameters for the Risk Adjustment Quality Assurance Auditors in keeping with department, corporate, state, and federal deadlines. Assists the Risk Adjustment Coding Educator Manager and Training Lead in identifying areas of opportunity for external business partners and internal coding and audit staff for coding and audit education based on internal quality assurance and state and federal audits.

Provides coaching, mentoring, and ongoing training to audit staff to enhance coding knowledge and audit performance. Conducts performance evaluations, goal setting, and regular feedback conversations via quarterly check‑ins. Ensure audits are conducted in accordance with CMS guidelines, ICD
10‑CM Official Coding Guidelines, risk adjustment coding standards, and organizational policies. Monitor audit quality, accuracy rates, and turnaround times. Assist in review of complex cases, as necessary. Serves as a subject matter expert for Risk Adjustment Audit and Coding. Advises staff on proper audit and coding practices through informal discussion and project validation. Evaluates day‑to‑day workload and processes to maximize productivity and efficiency ensuring all deadlines are met.

Assists leadership verifying and reporting staff productivity, quality and assigning audit due dates, setting project expectations, and monitors staff for timely project completion. Develops corrective action plans, training material, and performs training as needed. Maintains staff and departmental quality and volume related statistics and provides documentation to departmental management. Functions as a backup quality assurance auditor for risk adjustment audit functions and assists with day‑to‑day work as needed.

Executes audit projects in support of the Risk Adjustment Department strategy. Identifies and recommends the development of new processes, as necessary. Continually seeks and suggests process improvements to drive audit accuracy and productivity. Coordinates and performs all RADV audits and other audits as requested. Keeps management informed of project…