Remote Risk Adjustment Educator & Auditor

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

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC is seeking a Risk Adjustment Auditor to advance CMS payment accuracy and quality of care for WellCare contracted providers. You will conduct provider medical record audits, analyze MRA data, and serve as SME on risk adjustment coding.

You will organize training venues, coordinate educational work plans, and collaborate with Provider Relations, Quality, and Medical Directors to ensure CMS guidelines are met. Remote/hybrid options available.

Qualifications

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

Responsibilities

• Conduct provider medical record audits and risk adjustment education.
• Analyze MRA data to identify patterns and develop interventions.
• Act as SME for risk adjustment coding and CMS data validation.
• Coordinate educational work plans with WellCare contracted providers.
• Organize training venues (offices, hospitals, webinars, calls, email).
• Perform QA auditing for ICD-9/ICD-10 coding; communicate results.
• Collaborate with Provider Relations, Quality and Medical Directors to ensure CMS guidelines.
• Comply with all policies and standards.

Skills

Medical coding

Education/training

Quality assurance

Education

Bachelor's degree or equivalent experience

CPC

CCS

CRC

CPMA

Job description

Centene Management Company LLC is seeking a Risk Adjustment Auditor to advance CMS payment accuracy and quality of care for WellCare contracted providers. You will conduct provider medical record audits, analyze MRA data, and serve as SME on risk adjustment coding.

You will organize training venues, coordinate educational work plans, and collaborate with Provider Relations, Quality, and Medical Directors to ensure CMS guidelines are met. Remote/hybrid options available.