Risk Adjustment Auditor Educator

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

About the Role

Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analyze MRA data to identify patterns and develop interventions at the provider and market level. Serve as subject matter experts for proper risk adjustment coding and CMS data validation. Work in conjunction with other departments to include Provider Relations, Quality, and the Medical Director for the assigned state to ensure compliance with CMS risk adjustment guidelines.

Responsibilities

• Analyze MRA data to identify patterns and develop interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers.
• Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Work on additional risk adjustment audit requests (e.g., outside auditors’ requests).
• Serve on the RADV Committee as subject matter experts.
• Perform quality assurance auditing (e.g., ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists.
• Communicate QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics.
• Perform other duties as necessary.
• Comply with all policies and standards.

Requirements

• Bachelor’s degree or equivalent experience required.
• 5+ years of experience in a hospital, physician setting, or Managed Care Organization as a medical coder.
• 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding).
• Experience in teaching, training, or an educator/instructor role required; provider education experience is preferred.
• Managed Care experience preferred.

Qualifications

• A license in one of the following is required: CPC or CCS at hire.
• CRC required within the 1st year of employment.
• CPMA preferred in the 2nd year of employment.

Pay

$56,200.00 - $101,000.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.