Remote Risk Adjustment Auditor & Educator

Centene Management Company LLC; Nevada; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K plans

Tuition reimbursement

PTO and holidays

Job summary

Centene Management Company LLC seeks a Risk Adjustment Data Validator who will conduct provider medical record audits, analyze coding patterns, and develop education programs to ensure CMS payment accuracy and quality of care. The role includes leading training across offices, webinars, and calls, with involvement in RADV governance.

The candidate should have 5+ years in hospital or managed care coding, with CPC/CCS or CPMA/CRC certifications, and strong communication skills to coordinate with

Qualifications

• Experience in risk adjustment coding and CMS requirements.
• Ability to educate providers on Dx codes and documentation.
• Strong analytical skills for MRA data patterns and interventions.
• Teaching/training or educator role experience.

Responsibilities

• Audit medical records for ICD-9/ICD-10 coding accuracy and appropriateness.
• Lead provider education and risk adjustment training across venues (offices, webinars, calls).
• Analyze MRA data to identify patterns and develop education plans.
• Serve on the RADV Committee as subject matter experts.
• Communicate QA results and suggest retraining topics.

Skills

Managed Care experience

HCC methodology

Effective communication

Organizational skills

Education

Bachelor’s degree or equivalent experience

CPC or CCS

CPMA within 1 year

CRC within 2nd year

Job description

Centene Management Company LLC seeks a Risk Adjustment Data Validator who will conduct provider medical record audits, analyze coding patterns, and develop education programs to ensure CMS payment accuracy and quality of care. The role includes leading training across offices, webinars, and calls, with involvement in RADV governance.

The candidate should have 5+ years in hospital or managed care coding, with CPC/CCS or CPMA/CRC certifications, and strong communication skills to coordinate with