Remote RADV Auditor & Provider Education Lead

Centene Corporation; Carson City (NV); Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health Insurance

401K/Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation is seeking a Health Care Auditor/ Educator to conduct provider medical record audits and analyze CMS data patterns. The role involves educating providers on risk adjustment, coordinating with multiple departments, and delivering training across venues such as offices, hospitals, and webinars.

Qualifications include a Bachelor’s degree (or equivalent), 5+ years in medical coding in hospital/physician or Managed Care settings, and Medicare risk adjustment knowledge.

Qualifications

• Bachelor’s degree or equivalent experience required.
• 5+ years in hospital/physician or MCO medical coding roles.
• 2+ years coding with Medicare risk adjustment (HCC).
• Experience in teaching/training or educator roles preferred.
• Managed care experience is a plus.

Responsibilities

• Act 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-focused interventions.
• Educate providers on risk adjustment to improve CMS payments and care quality.
• Deliver training through offices, hospitals, webinars, calls, and emails.
• Support additional risk adjustment audit requests and RADV committee work.
• Communicate QA results and training needs to Medical Coding Specialists.

Skills

Risk adjustment coding

CMS data validation

Provider education

Training delivery

Communication & organization

Education

Bachelor’s degree or equivalent experience

2+ years coding experience

Medicare risk adjustment knowledge (HCC coding)

Job description

Centene Corporation is seeking a Health Care Auditor/ Educator to conduct provider medical record audits and analyze CMS data patterns. The role involves educating providers on risk adjustment, coordinating with multiple departments, and delivering training across venues such as offices, hospitals, and webinars.

Qualifications include a Bachelor’s degree (or equivalent), 5+ years in medical coding in hospital/physician or Managed Care settings, and Medicare risk adjustment knowledge.