Risk Adjustment Auditor – Educator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Execute audits of provider medical records

• Examine coding patterns within practices

• Create and provide education and training on risk adjustment for providers

• Analyze MRA data to detect trends and develop interventions tailored for providers and markets

• Organize educational work plans for providers contracted with WellCare

• Act as a subject matter expert in risk adjustment coding and CMS data validation

• Collaborate with Provider Relations, Quality, and the state Medical Director to ensure adherence to CMS risk adjustment guidelines

• Facilitate training sessions via provider offices, hospitals, webinars, conference calls, and email

• Address additional requests for risk adjustment audits, including those from outside auditors

• Serve as a subject matter expert on the RADV Committee

• Conduct quality assurance audits for Medical Coding Specialists, focusing on ICD-9/ICD-10 coding accuracy

• Share QA findings and suggest topics for improvement and retraining

• Carry out other responsibilities as required

• Adhere to all policies and standards

⛳️ Requirements

• Bachelor's degree or equivalent experience is mandatory

• Over 5 years of experience in a hospital, physician environment, or Managed Care Organization as a medical coder

• Minimum of 2 years of coding experience with an understanding of Medicare risk adjustment and HCC Coding

• Experience in a teaching, training, or educator/instructor role is essential

• Preference for candidates with provider education experience

• Additional managed care experience is preferred

• CPC or CCS certification is required upon hiring

• CRC certification must be obtained within the first year of employment

• CPMA certification preferred within the second year of employment

🏝️ Benefits

• Competitive salary

• Health insurance coverage

• 401K retirement plans

• Stock purchase options

• Tuition reimbursement opportunities

• Paid time off in addition to holidays

• Flexible work arrangements, including remote, hybrid, field, or office schedules

• Potential for incentives to be included in total compensation