Risk Adjustment Auditor Educator

Centene Corporation; Deutschland; Hybrid; EUR 48.000 - 87.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote,hyb

Flexible work arrangements

Zusammenfassung

Centene Corporation is seeking a risk adjustment auditor to conduct provider medical record audits, analyze coding patterns and educate providers to ensure accurate CMS payments and high-quality care.

You will coordinate with Provider Relations, Quality, and Medical Directors to comply with CMS risk adjustment guidelines and lead educational initiatives for contracted providers across markets.

Qualifikationen

• Bachelor’s degree or equivalent experience is required.
• 5+ years in hospital, physician setting, or MCO as medical coder.
• 2+ years coding experience with Medicare risk adjustment (HCC Coding).
• Experience teaching/training or educator role is required; provider education preferred.
• Managed care experience is a plus.

Aufgaben

• Serve as subject matter expert for risk adjustment coding and CMS data validation.
• Collaborate with Provider Relations, Quality and Medical Director to ensure CMS risk adjustment guidelines are met.
• Analyze MRA data to identify patterns and develop provider/market interventions.
• Conduct provider education and training to ensure accurate CMS payments and improve care quality.
• Deliver training across offices, hospitals, webinars, calls, and emails.
• Participate in RADV Committee as subject matter experts.
• Perform QA auditing for ICD-9/ICD-10 coding accuracy and appropriateness.
• Communicate QA results to Medical Coding Specialists and suggest retraining topics.
• Fulfill additional risk adjustment audit requests as needed.

Kenntnisse

Risk adjustment coding

CMS data validation

Provider education/training

MRA data analysis

QA and retraining

Ausbildung

Bachelor’s degree

Jobbeschreibung

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.
• Complies with all policies and standards

Education/Experience:

Bachelor’s degree or equivalent experience required

Candidate Experience:

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; but provider education experience is preferred
Preferred Other managed care experience

Licenses and Certifications:

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

CPMA preferred on the 2nd year of employment

Pay Range:

$56,200.00 - $101,000.00 per year

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act