Risk Adjustment Specialist (Non-Clinical)

Centene • Austin, PA

230d • $22 - $38

About The Position

The purpose of this job is to engage and educate providers on accurate capture and reporting of chronic conditions for revenue management purposes, ensuring that the program adheres to state and federal guidelines. The main functions include provider engagement, training, data analysis, and reporting. The position is responsible for outreach and engagement with 60-100 providers, focusing on training, providing monthly reporting, and using data to develop strategies and best practices that will help providers earn incentives and increase revenue by accurately capturing and documenting chronic conditions. Additionally, the role involves ensuring medical records are received and collaborating with vendors to overcome barriers, ensuring compliance with mandated audits and medical record requests. Outreach to providers will be conducted through phone, email, and Zoom meetings to educate them on projects and requirements, serving as the point of contact for questions, reports, and issues throughout the life of projects. The position requires the use of Excel and internal tools to develop reporting that details engagement, issues, and progress to ensure providers meet their goals. The role also involves reviewing and analyzing data from projects to identify barriers and develop strategies and best practices to assist providers in achieving project success. Professional oral and written communication skills are essential for communicating with providers via email, Zoom meetings, and phone to educate, provide updates, train, and serve as a resource to increase provider engagement in projects. The position also requires using various vendor portals to identify barriers that prevent the health plan from receiving medical records for risk adjustment purposes, researching provider information using internal systems and the internet, and sharing best practices to help reach corporate goals for medical record submission for coding and abstraction.

Requirements

• High School Diploma / GED.
• 2 years of Health Insurance, Customer Service, Claims, or Provider Office experience required.
• Health Insurance experience preferred.

Responsibilities

• Engage and educate providers on accurate capture and reporting of chronic conditions.
• Ensure program compliance with state and federal guidelines.
• Conduct outreach and engagement with 60-100 providers.
• Provide training and monthly reporting to providers.
• Develop strategies and best practices to help providers earn incentives.
• Ensure medical records are received and work with vendors to overcome barriers.
• Serve as the point of contact for provider questions and issues.
• Use Excel and internal tools for reporting on provider engagement and progress.
• Review and analyze project data to identify barriers.
• Communicate with providers via email, phone, and Zoom meetings.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules (remote, hybrid, field, or office).

What This Job Offers

• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED