Nevada Licensed Risk Adjustment Educator

Job Summary

To support accurate CMS payment and improve quality of care, the full-time Nevada Licensed Risk Adjustment Educator will conduct provider medical record audits, analyze coding patterns, and provide education and training remotely within the Southern Nevada Territory.

Key responsibilities

• Conduct provider education and training on risk adjustment coding and CMS guidelines
• Analyze MRA data to identify patterns and develop interventions for WellCare contracted providers
• Collaborate with other departments to ensure compliance with CMS risk adjustment guidelines

Required qualifications

• Bachelor's degree or equivalent experience
• 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)
• Teaching, training, or educator experience is required; provider education experience is preferred
• Current certification as CPC or CCS is required at the time of hire