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Risk Adjustment Audit and Education Consultant Job in San Jose, California

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Job Title: Risk Adjustment Audit and Education Consultant

Specialties:Risk Adjustment
Required Certifications:CPC
Required Experience:5 to 7 years
Preferred Experience:5 to 7 years
Location: San Jose 95127, CA, US
Date Posted:6/24/2019

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing patients a complete and pro-active health care experience, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.


Responsible for ensuring complete risk scores and accurate revenue and mitigating payment error risk via auditing, education, and training for proper diagnosis coding and documentation practices.


Primary duties may include, but are not limited to:

·         Identifies opportunities to improve accuracy and completeness for revenue impact.

·         Translates data to provide answers for provider consultations in order to improve medical record documentation and risk scores.

·         Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.

·         Develops and implements action plans to address issues identified through data analysis.

·         Provides oversight, guidance, and training to partner providers and clinicians related to CMS guidelines and HCC best practices.

·         Develops training programs and tools; performs internal process and policy audits.

Requires BA/BS in health sciences, health management, or nursing;

6 years of experience in healthcare including provider relationship management, ICD-9 coding, and experience in a consultative role, including 3 years of CMS Risk Adjustment experience; or any combination of education and experience, which would provide an equivalent background.

CPC or CCS from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.

Experience developing training programs and provider tools required.

Proficiency in programming, query and/or data analysis tools/software required.


Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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