Risk Adjustment Auditor – Educator

🔥 3 minutes ago

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 0%

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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 • Provide education and training regarding risk adjustment • Analyze MRA data to identify patterns and develop interventions at provider and market levels • Coordinate an educational work plan for WellCare contracted providers • Work with Provider Relations, Quality, and the state Medical Director to ensure compliance with CMS risk adjustment guidelines • Conduct provider education and training through provider offices, hospitals, webinars, conference calls, and email correspondence • Work on additional risk adjustment audit requests, including outside auditors’ requests • Serve as a subject matter expert on the RADV Committee • Perform quality assurance auditing of ICD-9/ICD-10 coding for WellCare’s Medical Coding Specialists • Communicate QA results and recommend improvement and retraining topics • Perform other duties as assigned • 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) • Teaching, Training or an Educator/Instructor role required • CPC or CCS certification required at the time of hire • CPMA required within the first year of employment • CRC required in the second year of employment • Managed Care experience preferred • Strong understanding of HCC methodology, risk-adjustable diagnoses, CMS requirements, and compliant diagnosis capture • Ability to accurately evaluate diagnosis coding and determine whether documentation supports the reported code • Experience working with and educating providers around diagnosis codes • Clear communication, strong organizational skills, and flexibility

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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