Remote Risk Adjustment Educator & Auditor

Centene Corporation; Las Vegas (NV); Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off + holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation is seeking a remote risk adjustment auditor to conduct provider medical record audits and educate providers on CMS risk-adjustment coding. The role emphasizes collaboration with Provider Relations, Quality teams and the Medical Director for the state in focus to ensure CMS guidelines are met.

The candidate will analyze MRA data, identify patterns, and develop educational interventions for WellCare-contracted providers, delivering training through offices, webinars, and calls.

Qualifications

• 5+ years of experience in a hospital, physician setting or a Managed Care Organization as a medical coder.
• Experience teaching, training or educator roles; provider education preferred.
• Medicare risk adjustment (HCC coding) knowledge required.

Responsibilities

• Conduct provider medical record audits and risk adjustment training.
• Analyze MRA data to identify patterns and develop provider-level interventions.
• Coordinate with Provider Relations, Quality and Medical Director to ensure CMS risk adjustments compliance.
• Provide QA auditing of ICD-9/ICD-10 coding and communicate findings for retraining.
• Perform other duties as assigned and comply with policies.

Skills

Managed Care experience

HCC methodology

CMS requirements

Dx codes education

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation is seeking a remote risk adjustment auditor to conduct provider medical record audits and educate providers on CMS risk-adjustment coding. The role emphasizes collaboration with Provider Relations, Quality teams and the Medical Director for the state in focus to ensure CMS guidelines are met.

The candidate will analyze MRA data, identify patterns, and develop educational interventions for WellCare-contracted providers, delivering training through offices, webinars, and calls.