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Corporate Functions & Operations WellCare - Coding & Records Careers

Risk Adjustment Auditor Education Job

Full Job Title: Risk Adjustment Auditor Ed

Job Number: 1803524

Location: Chicago, IL

Date Posted: 5-25-2018

Department: Health Services-RAPS

Reports to: Sr. Manager, Risk Adjustment Programs

Location: 29 North Wacker Drive, Chicago, IL 60606

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 role requires the selected candidate to travel (upwards of 70%) in the assigned territory.

Essential Functions:

  • 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.
Additional Responsibilities:Candidate Education:
  • Required: A Bachelor's Degree in a health related field or finance
Candidate Experience:
  • Required: 3 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)
  • Preferred: Other provider education experience
Candidate Skills:
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Intermediate Ability to represent the company with external constituents
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated organizational skills
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to work independently
Licenses and Certifications:
A license in one of the following is required:
  • Required Other One of the following certifications are required: CPC, CCS, CRC
  • Required Other CPMG is required within the first year of employment
Technical Skills:
  • Required Intermediate Microsoft Outlook Knowledge in Microsoft Office including Outlook, Word, Excel, Visio, and Power Point
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Visio
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft PowerPoint

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Last Updated On: 12/9/2015