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Risk Adjustment Auditor Provider Educator Job in Wisconsin, Wisconsin

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Job Title: Risk Adjustment Auditor Provider Educator

Employer:Collaborative Health Systems
Type:FULL TIME, OTHER
Job Location:Remote
Skills:Medical Record review,knowledge of ICD 10 cm guidelines
Specialties:Outpatient
Required Certifications:CPC-A,CPC
Preferred Certifications:CPC
Required Experience:1 to 2 years
Preferred Experience:1 to 2 years
Location: Wisconsin 53201, WI, US
* Note: This listing is for a remote position
Date Posted:4/22/2021
https://jobs.centene.com/us/en/job/1222934/Risk-Adjustment-Auditor-Educator 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. • 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). • 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. Additional Responsibilities: Education/Experience: High School or GED required, an Associate's Degree in Health Information, Health Administration or other relevant field preferred 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) Outpatient Coding experience preferred Experience in teaching, training or an educator/instructor role required; but provider education experience is preferred Managed care experience preferred Licenses and Certifications: CPC or CCS required at the time of hire Required Other CPMA is required within the first year of employment Required Other CRC required on the second year of employment

Applying

Johanna.decelleri@collaborativehs.com

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