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Risk Adjustment Auditor Educator Job in Chicago, Illinois

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Job Title: Risk Adjustment Auditor Educator

Employer:Centene Corporation
Type:Full-Time
Specialties:Medicare Risk Adjustment (HCC Coding)
Required Certifications:CPC or CCS
Preferred Certifications:CPMA
Required Experience:5 to 7 years
Location:Chicago, IL
Date Posted:8/21/2020

Position Purpose: Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level.

Essential Functions:

  • Subject matter experts for proper risk adjustment coding and CMS data validation
  • Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met.
  • Analyze MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers.
  • Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
  • Works on additional risk adjustment audit requests (i.e. outside auditors’ requests).
  • Serves on the RADV Committee as subject matter experts.
    Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists.
  • Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics.
  • Perform other duties as necessary.
Candidate Education: Required A High School or GED.
Preferred An Associate's Degree in Health Information, Health Administration or other relevant field.
 
Candidate Experience: Required 5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder
Required 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)
Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred
Preferred Other managed care experience Licenses and Certifications: A license in one of the following is required: Required Other One of the following certifications are required at the time of hire: CPC or CCS
Required Other CPMA is required within the first year of employment
Required Other CRC required on the second year of employment

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


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