Risk Adjustment Coding Compliance Analyst (Non-Clinical)

Centene Corporation

1d • 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. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Executes Line 2 oversight of Risk Adjustment activities, to include identifying compliance risks, auditing coding practices, adherence to CMS guidelines and supports Line 1 oversight. Identifies and assesses risk levels and effectively communicates findings to business stakeholders to ensure the quality of risk adjustment data. Ensure coding accuracy by reviewing inpatient and outpatient medical records in accordance with International Classification of Diseases, Tenth Revision (ICD-10), Coding Clinic, AHIMA, and the company’s coding guidelines. Apply ICD-10, AHIMA, Coding Clinic, and company’s coding guidelines to ensure accurate and compliance coding practices. Implement CMS risk adjustment guidelines to support accurate coding and compliance with regulatory standards. Review and appropriately challenge coding decisions based on current industry guidelines, audit findings, and regulatory requirements. Conduct Line 1 gap analysis and provide best practice recommendations, while designing and executing Line 2 audits to evaluate the effectiveness and compliance of risk adjustment quality programs. Provide guidance on CMS coding requirements and industry best practices. Assess risk levels in coding data and recommend mitigation strategies. Evaluate policy and procedures to ensure completeness, adherence to current requirements, and best practices. Support remediation efforts for identified non-compliance issues. Performs other duties as assigned. Complies with all policies and standards.

Requirements

• High School Diploma or GED required
• 2+ years Professional coding experience in a hospital, physician, or health plan setting required
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required

Nice To Haves

• Associate's Degree in related field preferred
• 5+ years Professional coding experience in a hospital, physician, or health plan setting preferred
• Managed care experience preferred
• Certified Risk Adjustment Coder (CRC) preferred

Responsibilities

• Executes Line 2 oversight of Risk Adjustment activities, to include identifying compliance risks, auditing coding practices, adherence to CMS guidelines and supports Line 1 oversight.
• Identifies and assesses risk levels and effectively communicates findings to business stakeholders to ensure the quality of risk adjustment data.
• Ensure coding accuracy by reviewing inpatient and outpatient medical records in accordance with International Classification of Diseases, Tenth Revision (ICD-10), Coding Clinic, AHIMA, and the company’s coding guidelines.
• Apply ICD-10, AHIMA, Coding Clinic, and company’s coding guidelines to ensure accurate and compliance coding practices.
• Implement CMS risk adjustment guidelines to support accurate coding and compliance with regulatory standards.
• Review and appropriately challenge coding decisions based on current industry guidelines, audit findings, and regulatory requirements.
• Conduct Line 1 gap analysis and provide best practice recommendations, while designing and executing Line 2 audits to evaluate the effectiveness and compliance of risk adjustment quality programs.
• Provide guidance on CMS coding requirements and industry best practices.
• Assess risk levels in coding data and recommend mitigation strategies.
• Evaluate policy and procedures to ensure completeness, adherence to current requirements, and best practices.
• Support remediation efforts for identified non-compliance issues.
• 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
• Education Level: High school or GED