Risk Adjustment Auditor Educator

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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose

• Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care.
• Analysis of MRA data to identify patterns and development of interventions at the provider and market level.
• Act as subject matter experts for proper risk adjustment coding and CMS data validation.
• Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met.
• Coordinate an educational work plan for WellCare contracted providers following analysis of MRA data to identify patterns and development of interventions at the provider and market level.
• Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and to improve quality of care.
• Organize training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Work on additional risk adjustment audit requests (i.e. outside auditors’ requests).
• Serve on the RADV Committee as subject matter experts.
• Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists.
• Communicate QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics.
• Perform other duties as necessary.
• Comply with all policies and standards.

Education / Experience

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

Licenses and Certifications

• A license in one of the following is required.
• One of the following licensures required at hire: CPC or CCS.
• CRC required within the 1st year of employment.
• CPMA preferred on the 2nd year of employment.

Pay Range

$56,200.00 - $101,000.00 per year

Benefits

• Competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.