Remote Risk Adjustment Educator & Auditor

Centene Corporation; United States; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

PTO & holidays

Remote/hybrid work

Job summary

Centene Corporation seeks a remote Radv/Risk-Adjustment Education Specialist for the Southern Nevada Territory. You will audit provider medical records, analyze CMS risk adjustment patterns, and develop interventions with cross-functional teams. Training venues include offices, webinars, calls, and emails.

The role requires 5+ years in hospital/physician/MCO coder roles, HCC coding knowledge, and teaching experience; CPC/CCS/CPMA/CRC certifications preferred. Salary range shown below.

Qualifications

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

Responsibilities

• Conduct provider medical record audits and risk adjustment training.
• Analyze MRA data to identify patterns and interventions.
• Coordinate with Provider Relations, Quality and Medical Director for CMS risk adjustments.
• Educate providers on risk-adjustment coding and CMS requirements.
• Serve on RADV Committee as subject matter expert.
• Perform QA auditing for ICD-9/ICD-10 coding and provide retraining recommendations.

Skills

Managed Care experience

HCC methodology

CMS requirements

Diagnosis coding

Provider education

Communication

Organization

Flexibility

Education

Bachelor’s degree

Certifications: CPC

Certifications: CCS

Tools

CPMA

CRC

Job description

Centene Corporation seeks a remote Radv/Risk-Adjustment Education Specialist for the Southern Nevada Territory. You will audit provider medical records, analyze CMS risk adjustment patterns, and develop interventions with cross-functional teams. Training venues include offices, webinars, calls, and emails.

The role requires 5+ years in hospital/physician/MCO coder roles, HCC coding knowledge, and teaching experience; CPC/CCS/CPMA/CRC certifications preferred. Salary range shown below.