Risk Adjustment Auditor Educator

Centene
Georgia, Florida
Workplace: RemoteFull timeUSD 56,200 - 101,000 annuallyFunction: Education & TrainingExperience: 5+ yearsEducation: bachelorsSkills: ["Analysis","Quality assurance","Communication","Training","Coding accuracy"]

Conduct provider medical record audits and analyze risk adjustment data to validate CMS payments and improve quality of care. Serve as a subject matter expert on risk adjustment coding, perform QA auditing for ICD-9/ICD-10 appropriateness, and communicate findings to medical coding specialists. Educate and train WellCare contracted providers using an educator work plan, venues, and RADV committee expertise.

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FursaFursa
Centene
Centene
1 day ago

Risk Adjustment Auditor Educator

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 4 months ago

Job Summary

Conduct provider medical record audits and analyze risk adjustment data to validate CMS payments and improve quality of care. Serve as a subject matter expert on risk adjustment coding, perform QA auditing for ICD-9/ICD-10 appropriateness, and communicate findings to medical coding specialists. Educate and train WellCare contracted providers using an educator work plan, venues, and RADV committee expertise.
Location: Georgia, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Education & Training
Seniority: Mid level

Key Responsibilities

  • •Conduct provider medical record audits and analyze practice coding patterns to ensure accurate CMS payment and improve quality of care.
  • •Serve as a subject matter expert for proper risk adjustment coding and CMS data validation.
  • •Work with Provider Relations, Quality, and the Medical Director to ensure compliance with CMS risk adjustment guidelines.
  • •Analyze MRA data to identify patterns and develop interventions and an educational work plan for WellCare contracted providers.
  • •Perform quality assurance auditing of ICD-9/ICD-10 coding and communicate QA results to medical coding specialists with improvement and retraining topics.

Pay and Benefits

Salary: USD 56,200 - 101,000 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s degree or equivalent experience required.
  • •5+ years of experience as a medical coder in a hospital, physician setting, or Managed Care Organization.
  • •2+ years of coding experience with knowledge of Medicare risk adjustment (HCC coding).
  • •Required: teaching, training, or an educator/instructor role (provider education experience preferred).
  • •At hire: CPC or CCS license required; CRC required within the first year; CPMA preferred on the second year.
Experience:5+ yearsHealthcareMedical codingManaged careMedicare risk adjustmentCMSHCC coding
Education:Bachelor's
Skills:AnalysisQuality assuranceCommunicationTrainingCoding accuracy
Licenses:CPCCCSCRCCPMA
Certifications:CPCCCSCRCCPMA
Tech Stack:ICD-9ICD-10Medicare risk adjustmentHCC codingCMS paymentMRA dataRADVCMS risk adjustment guidelines

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn