Risk Adjustment Auditor – Educator

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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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 • Develop and deliver risk adjustment education and training for providers • Analyze MRA data to identify patterns and develop provider- and market-level interventions • Coordinate educational work plans for WellCare contracted providers • Serve as a subject matter expert on risk adjustment coding and CMS data validation • Work with Provider Relations, Quality, and the state Medical Director to ensure compliance with CMS risk adjustment guidelines • Deliver training through provider offices, hospitals, webinars, conference calls, and email correspondence • Handle additional risk adjustment audit requests, including outside auditor requests • Serve as a subject matter expert on the RADV Committee • Perform quality assurance audits for Medical Coding Specialists, including ICD-9/ICD-10 coding accuracy reviews • Communicate QA results and recommend improvement and retraining 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, physician setting, or Managed Care Organization as a medical coder • 2+ years of coding experience with knowledge of Medicare risk adjustment and HCC Coding • Experience in teaching, training, or an educator/instructor role required • Provider education experience preferred • Other managed care experience preferred • CPC or CCS licensure required at hire • CRC required within the first year of employment • CPMA preferred in the second year of employment

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Incentives may be included in total compensation