Risk Adjustment Auditor Educator

Centene Corporation

2d • Remote

About The Position

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. Position Purpose: 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. 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. Additional Responsibilities: Performs other duties as assigned Complies with all policies and standards

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) Required
• Other experience in teaching, training or an educator/instructor role required
• A license in one of the following is required: One of the following licensures required at hire: CPC or CCS
• CRC required within the 1st year of employment

Nice To Haves

• provider education experience is preferred
• Other managed care experience
• CPMA preferred on the 2nd year of employment

Responsibilities

• 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
• 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
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
• 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 may be subject to program eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees