Remote Risk Adjustment Auditor & Educator

Centene Corp.; Northern (KY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase plan

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corp. is seeking a seasoned Risk Adjustment Auditor to audit provider medical records, analyze CMS risk adjustment patterns, and educate providers to improve CMS payments and care quality.

The role involves collaborating with Provider Relations, Quality, and Medical Directors to ensure CMS guidelines are met and coordinating training across WellCare contracted providers. Relevant licensure and managed care experience are required.

Qualifications

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

Responsibilities

• Conduct provider medical record audits and risk adjustment education to ensure CMS payment accuracy.
• Analyze MRA data to identify patterns and develop provider-level interventions.
• Serve as subject matter expert for risk adjustment coding and CMS data validation.
• Coordinate education with Provider Relations, Quality, and Medical Directors to ensure CMS risk adjustments guidelines are met.
• Organize training venues (offices, hospitals, webinars, calls, email) and respond to external audit requests.
• Serve on the RADV Committee as subject matter experts.
• Perform QA auditing of ICD-9/ICD-10 coding and report results with improvement suggestions.

Skills

Medical coding

Risk adjustment

Education/training

CMS data validation

Communication

Education

Bachelor’s degree or equivalent experience

CPC or CCS licensure

CRC within 1st year

CPMA preferred in 2nd year

Job description

Centene Corp. is seeking a seasoned Risk Adjustment Auditor to audit provider medical records, analyze CMS risk adjustment patterns, and educate providers to improve CMS payments and care quality.

The role involves collaborating with Provider Relations, Quality, and Medical Directors to ensure CMS guidelines are met and coordinating training across WellCare contracted providers. Relevant licensure and managed care experience are required.