Department: Health Services-RAPS
Reports to: Supervisor, Risk Adjustment Audit
Location: 10803 Hope Street, Cypress, CA 90630
WellCare has an exciting opportunity for a Risk Adjustment Auditor Educator to join our team! The selected candidate will 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. This position is California based or remote reporting to the local WellCare office and requires the selected candidate to travel (upwards of 70%) in the assigned territory including but not limited to the state you live in with the possibility of other adjacent states.
This position is ideal for someone looking for professional growth and enjoys interacting with providers. A few of the primary responsibilities include assisting providers in understanding the CMS-HCC Risk Adjustment program as it relates
to the importance of proper chart documentation and diagnosis coding. The candidate will utilize analytics to identify target providers for Medicare Risk Adjustment training and documentation/coding resources. Ultimately, the candidate will provide feedback to providers via webinar, teleconference, or in-person training for small and large groups.
While our ideal candidate will have risk adjustment experience, we will train and welcome candidates who have solid coding/auditing experience and provider education experience.
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).
- Serves on the RADV Committee as subject matter experts.
- 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.
- Required A High School or GED
- Preferred An Associate's Degree in Health Information, Health Administration or other relevant field
- Required 5 years of experience in a hospital or physician setting as a medical coder
- Required 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:
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Demonstrated written communication skills
- Advanced Ability to represent the company with external constituents
- Advanced Knowledge of medical terminology and/or experience with CPT and ICD-10 coding
- Advanced Other Proficient in public speaking, presentations, and educational activities
- Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated organizational skills
- Intermediate Ability to work as part of a team
- Intermediate Ability to work independently
A license in one of the following is required:
- Required Other One of the following certifications are required at the time of hire: CPC or CCS
- Required Other CPMA is required within the first year of employment
- Required Other CRC required on the second year of employment
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Visio
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint