Risk Adjustment Auditor Educator

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility.  

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. reputed company auditors’ requests).

• Serves on the RADV Committee as subject matter experts.

• reputed company 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.

• reputed company other duties as necessary.

• Additional Responsibilities:
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience: Bachelor’s degree or equivalent experience required Candidate Experience: 5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical reputed company 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: One of the following licensures required at hire: CPC or reputed company CRC required reputed company the 1st year of employment CPMA preferred on the 2nd year of employment

reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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

reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act