Risk Adjustment Auditor – Educator

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

📋 Description

• Perform audits of provider medical records.

• Evaluate coding patterns within the practice.

• Offer education and training on risk adjustment topics.

• Examine MRA data to uncover patterns and create interventions at both provider and market levels.

• Develop an educational work plan tailored for WellCare contracted providers.

• Collaborate with Provider Relations, Quality, and the state Medical Director to guarantee compliance with CMS risk adjustment regulations.

• Facilitate provider education and training via provider offices, hospitals, webinars, conference calls, and email communications.

• Address additional risk adjustment audit requests, including those from external auditors.

• Act as a subject matter expert on the RADV Committee.

• Conduct quality assurance audits of ICD-9/ICD-10 coding for WellCare’s Medical Coding Specialists.

• Share QA findings and propose topics for improvement and retraining.

• Carry out other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• A bachelor’s degree or equivalent experience is mandatory.

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

• More than 2 years of coding experience with a focus on Medicare risk adjustment (HCC Coding).

• Experience in a teaching, training, or educator/instructor capacity is required.

• CPC or CCS certification is essential at the time of hire.

• CPMA certification must be obtained within the first year of employment.

• CRC certification is required within the second year of employment.

• Managed Care experience is preferred.

• Strong comprehension of HCC methodology, risk-adjustable diagnoses, CMS requirements, and compliant diagnosis capture.

• Capability to accurately assess diagnosis coding and verify documentation support for the reported code.

• Background in working with and educating providers on diagnosis codes.

• Excellent communication skills, strong organizational abilities, and adaptability are essential.

🏝️ Benefits

• Competitive salary.

• Health insurance options.

• 401K plan.

• Stock purchase programs.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentive forms may be included in total compensation.

• Equal opportunity employer dedicated to diversity.