[Hiring] Risk Adjustment Auditor Educator @Centene Corporation

Role Description

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. Analysis of MRA data to identify patterns and development of interventions at the provider and market level.

• Remote role with Southern Nevada Territory
• Subject matter experts for proper risk adjustment coding and CMS data validation
• Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met.
• Analyze MRA data to identify patterns and development of 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 to ensure accurate CMS payment and to improve quality of care.
• This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Works on additional risk adjustment audit requests (i.e. outside auditors’ requests).
• Serves on the RADV Committee as subject matter experts.
• Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists.
• Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics.
• Perform other duties as necessary.

Qualifications

• Managed Care experience
• Strong understanding of HCC methodology, risk-adjustable diagnoses, CMS requirements, and compliant diagnosis capture.
• Accurately evaluates diagnosis coding and determines whether documentation supports the reported code.
• Experience working with and educating providers around Dx codes.
• Clear communication, strong organizational skills, flexibility.

Requirements

• 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)
• Teaching, Training or an Educator/Instructor role required; but provider education experience is preferred
• Preferred: managed care experience

Licenses and Certifications

• One of the following certifications are required at the time of hire: CPC or CCS
• CPMA is required within the first year of employment
• CRC required on the second 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