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Risk Adjustment Auditor Educator
Centene • NV, US • published 2026-11-04 15:16:16.137635
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**Position Purpose:** 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. **Key Details:** Remote role with Southern Nevada Territory * 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). * Se...
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