Risk Adjustment Auditor, Educator

🕒 August 18

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 27%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Conduct provider medical record audits • Analyze practice coding patterns • Provide education and training regarding risk adjustment • Analyze MRA data to identify patterns and develop interventions at the provider and market level • Work with Provider Relations, Quality and the Medical Director for the assigned state to ensure CMS risk adjustment guideline compliance • Coordinate an educational work plan for WellCare contracted providers • Conduct training through provider offices, hospitals, webinars, conference calls and email correspondence • Work on additional risk adjustment audit requests, including outside auditors’ requests • Serve on the RADV Committee as a subject matter expert • Perform quality assurance auditing for WellCare’s Medical Coding Specialists, including ICD-9/ICD-10 coding accuracy • Communicate QA results and suggest improvement and re-training topics • Perform other duties as necessary • Comply with all policies and standards

🎯 Requirements

• 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 • 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 • Preferred other managed care experience

🏖️ Benefits

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