Certified Risk Adjustment Educator

Job Summary

To enhance the quality of care and ensure accurate CMS payment, the full-time Certified Risk Adjustment Educator will conduct provider medical record audits, analyze coding patterns, and provide education and training remotely.

Key responsibilities

• Conduct provider medical record audits and analyze MRA data to identify patterns and develop interventions
• Provide education and training on risk adjustment coding to WellCare contracted providers through various venues
• Collaborate with departments such as Provider Relations and Quality to ensure compliance with CMS risk adjustment guidelines

Required qualifications

• Bachelor's degree or equivalent experience required
• 5+ years of experience in a hospital, physician setting, or Managed Care Organization as a medical coder
• 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)
• Experience in teaching, training, or an educator/instructor role required; provider education experience preferred
• Licensure as CPC or CCS required at hire; CRC required within the first year of employment