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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

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