Risk Adjustment Auditor – Educator
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Job Description
Centene risk adjustment auditor educator improving healthcare coding accuracy for Georgia and Florida providers. Auditing records, analyzing MRA data, and training contracted healthcare providers.
Responsibilities:
- 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
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