Remote Risk Adjustment Auditor & Educator

Centene Corp.; Nevada; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Remote role

Competitive benefits package

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corp. in the United States (Nevada region) seeks a Remote Risk Adjustment Auditor to conduct provider medical record audits and analyze CMS risk adjustment data.

The role focuses on training providers, ensuring compliant coding, and coordinating with Provider Relations, Quality, and Medical Directors in the Southern Nevada Territory. The ideal candidate has 5+ years as a medical coder within hospital/physician or Managed Care, with 2+ years in Medicare risk adjustment (HCC).

Qualifications

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

Responsibilities

• Lead risk adjustment audits and CMS data validation with provider relations and quality teams.
• Analyze MRA data to identify patterns and develop provider/market interventions.
• Educate providers on risk adjustment and CMS requirements through trainings and webinars.
• Communicate QA results and provide retraining recommendations.
• Serve on RADV Committee as subject matter expert.
• Perform quality assurance auditing of ICD-9/ICD-10 coding.
• Deliver training across offices, hospitals, webinars, calls, and emails.
• Comply with policies and standards.

Skills

Managed Care

HCC Coding

Provider Education

Communication

Organization

Education

Bachelor’s degree

Job description

Centene Corp. in the United States (Nevada region) seeks a Remote Risk Adjustment Auditor to conduct provider medical record audits and analyze CMS risk adjustment data.

The role focuses on training providers, ensuring compliant coding, and coordinating with Provider Relations, Quality, and Medical Directors in the Southern Nevada Territory. The ideal candidate has 5+ years as a medical coder within hospital/physician or Managed Care, with 2+ years in Medicare risk adjustment (HCC).