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Corporate Functions & Operations WellCare - Coding & Records Careers

Risk Adjustment Audit - Supervisor Job

Full Job Title: Supv, Risk Adjustment Audit

Job Number: 1801177

Location: Tampa, FL

Date Posted: 2-20-2018

Supervise the daily operations and work flow of the Medical Coding Auditors ensuring that all assigned audits are completed with a 97% accuracy rate. Provide guidance to the RAPS Medical Coding Auditor to ensure proper ICD-10 coding and CMS compliance is met. Establish and maintain relationships with external vendors to ensure proper coding is being done on our members medical records.

Essential Functions:
  • Subject matter expert (SME) for proper risk adjustment coding and CMS data validation;
  • Provides guidance and motivation to the team in their day to day job functions, actively mentoring and providing training as needed;
  • Conducts staff meetings - instilling a team approach, focused on meeting productivity goals and compliance metrics;
  • Provides ongoing training and continuing education regarding Risk Adjustment and ICD-10 coding through written materials, conference calls, Webinars, or presentations;
  • Responsible for overseeing all additional risk adjustment audit requests (i.e. internal and external audit requests);
  • Track and trend for coding accuracy on our external vendors
  • Responsible for performing other duties as necessary or as assigned.
Additional Responsibilities:
  • Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director to ensure compliance of CMS Risk Adjustment guidelines are being met;
Candidate Education:
  • Required A Bachelor's Degree in a related field or equivalent work experience ( 2 years)
Candidate Experience:
  • Required 3 years of experience in a hospital or physician setting
  • Required 3 years of experience in risk adjustment coding/auditing
Candidate Skills:
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Advanced Demonstrated organizational skills
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to work independently
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Licenses and Certifications:
A license in one of the following is required:
  • Required Certified Professional Coder (CPC) CPC required
  • Required Certified Professional Medical Auditor (CPMA)
  • Preferred Other Certified Risk Adjustment Coder (CRC)
Technical Skills:
  • Required Intermediate Other Knowledge of RAPS and HEDIS
  • Required Intermediate Microsoft Excel Knowledge in Microsoft Office including Outlook, Word, Excel, Visio, and Power Point
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Visio
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft PowerPoint

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Last Updated On: 12/9/2015