[Hiring] Risk Adjustment Auditor Educator @Centene Corporation

Role Description

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.

• 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.
• Subject matter expert for proper risk adjustment coding and CMS data validation.
• Work in conjunction with other departments to ensure compliance with CMS risk adjustments guidelines.
• Analyze MRA data to identify patterns and develop interventions at the provider and market level.
• Coordinate an educational work plan for WellCare contracted providers.
• Conduct provider education and training regarding risk adjustment.
• Training venues include provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Work on additional risk adjustment audit requests (i.e. outside auditors’ requests).
• Serve on the RADV Committee as subject matter expert.
• Perform quality assurance auditing 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.

Qualifications

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

Requirements

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

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