Risk Adjustment Auditor Educator

Centene Corporation•Remote-GA, FL

1d•$56,200 - $101,000•Hybrid

About The Position

Centene is seeking a Risk Adjustment Auditor Educator to join their team. This role is crucial in transforming the health of their 28 million members by ensuring accurate CMS payment and improving the quality of care through provider education and medical record audits. The position involves analyzing practice coding patterns, educating providers on risk adjustment, and identifying intervention opportunities at both the provider and market levels. The ideal candidate will be a subject matter expert in risk adjustment coding and CMS data validation, collaborating with various departments to ensure compliance with guidelines. This role also includes performing quality assurance audits on medical coding specialists and communicating findings for improvement.

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.
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.
Managed care experience.
CPMA preferred on the 2nd year of employment.

Responsibilities

Conduct provider medical record audits.
Analyze practice coding patterns.
Educate and train providers 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.
Coordinate an educational work plan for WellCare contracted providers.
Conduct provider education and training through various venues such as provider offices, hospitals, webinars, conference calls, and email correspondence.
Work on additional risk adjustment audit requests, including those from outside auditors.
Serve on the RADV Committee as a subject matter expert.
Perform quality assurance auditing to ensure the appropriateness and accuracy of ICD-9/ICD-10 coding for WellCare’s Medical Coding Specialists.
Communicate QA results to Medical Coding Specialists with suggestions for improvement and re-training topics.
Perform other duties as necessary.
Comply with all policies and standards.