HoustonRecruiter Since 2001
the smart solution for Houston jobs

Risk Adjustment Auditor Educator (Houston, TX)

Company: Wellcare Health Plans
Location: Houston
Posted on: September 15, 2019

Job Description:

Location: Houston, TexasDepartment: HS-Encounters & RAPSReports to: Manager, Risk Adjustment Audit & Provider EducationConduct 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.Essential Functions:Subject matter experts for proper risk adjustment coding and CMS data validationWork 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 High School or GEDPreferred An Associate's Degree in Health Information, Health Administration or other relevant field Candidate Experience:Required 5 years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coderRequired 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 preferredPreferred Other managed care experience Candidate Skills:Advanced Demonstrated interpersonal/verbal communication skillsAdvanced Demonstrated written communication skillsAdvanced Ability to represent the company with external constituentsAdvanced Knowledge of medical terminology and/or experience with CPT and ICD-10 codingAdvanced Other Proficient in public speaking, presentations, and educational activitiesIntermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial recordsIntermediate Demonstrated written communication skillsIntermediate Demonstrated organizational skillsIntermediate Ability to work as part of a teamIntermediate 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 at the time of hire: CPC or CCSRequired Other CPMA is required within the first year of employmentRequired Other CRC required on the second year of employment Technical Skills:Required Intermediate Microsoft OutlookRequired Intermediate Microsoft ExcelRequired Intermediate Microsoft VisioRequired Intermediate Microsoft WordRequired Intermediate Microsoft PowerPoint Languages:About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Houston , Risk Adjustment Auditor Educator (Houston, TX), Accounting, Auditing , Houston, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Accounting, Auditing Jobs


Controller
Description: The role of the Controller is an integral part of the Business Office, responsible for coordinating and assisting in the preparation of financial reports such as statements of activities, statements of (more...)
Company: Duchesne Academy Of The Sacred Heart
Location: Houston
Posted on: 09/16/2019

Tax Senior Associate
Description: Responsibilities br br br ul br br li Provide tax compliance, tax provision, and tax advisory services to pass-through and C-corporation entities with an emphasis on companies operating (more...)
Company: BKD
Location: Houston
Posted on: 09/16/2019

Credentialed Bilingual Tax Advisor - CPA - Remote
Description: OverviewJoin Our Virtual Tax Network At Intuit, our mission is to power prosperity around the world. Tax experts support that mission to our TurboTax customers by: providing valuable guidance, instilling (more...)
Company: Intuit
Location: Houston
Posted on: 09/16/2019


Senior Tax Analyst
Description: Id: EB-2136866776 Location: Houston, TX Job Type: FullTimeRegular One of the leaders in its industry, my client is seeking an experienced tax accountant to join its team. This position is open due to (more...)
Company: Creative Financial Staffing
Location: Houston
Posted on: 09/16/2019

Commodity Documentation Expert (Oil & Gas Futures)
Description: Merge your passion to of investing and trading commodities futures contracts with Houston's primary export of oil and gas. Gain experience and prestige with a global financial leader who is seeking a (more...)
Company: PathFinder Staffing
Location: Pasadena
Posted on: 09/16/2019

Night Audit Clerk - Jesse H. Jones Rotary House International (17000SIG)
Description: Its a powerful feeling, to belong. Its inspiring people to do more than they thought they could. Its leading the way by rolling up your sleeves to accomplish a common goal. Its taking a passion and turning (more...)
Company: Marriott
Location: League City
Posted on: 09/16/2019

Preseason Tax Professional
Description: br Pre-season Tax Professional br br Seeking seasonal tax preparers to serve clients with diverse tax needs during the pre-season. br H R Block pre-season tax professionals are responsible for (more...)
Company: H&R BLOCK
Location: Baytown
Posted on: 09/16/2019

Entry Level Financial Advisor
Description: We're More Than Insurance At Mutual of Omaha, we're not afraid to step outside the box and release the potential for ultimate success. We are a Fortune 500 company that allows you to carve your own professional (more...)
Company: Mutual of Omaha
Location: Bellaire
Posted on: 09/16/2019

Accounts Receivable Billing Clerk
Description: Company Profile br br Oceaneering is a global provider of engineered services and products, primarily to the offshore energy industry. We develop products and services for use throughout the lifecycle (more...)
Company: Oceaneering
Location: Houston
Posted on: 09/16/2019

Audit Senior Associate
Description: We are seeking an Audit Senior / Supervisor with 2 to 5 years of experience in public accounting. A successful candidate will be an experienced leader who is a motivated self-starter
Company: Miller Grossbard Advisors
Location: Houston
Posted on: 09/16/2019

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Houston RSS job feeds