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Senior Risk Adjustment Coding Analyst
Centene Corporation

Location: Tempe, Arizona
Work Setting: Other
Job Function:
Auditor, Coder, Coding – Auditor, Coding Supervisor/Manager
Job Type:
Full-Time

Introduction

Position Purpose: Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks. Assist with risk adjustment data validation and other risk adjustment audits.

Job Description

 

  • alidate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records
  • Analyze results of risk adjustment coding validation to identify coding patterns, recommend general and specific provider education topics, and assist with the development of the communication
  • Determine coding issues and discrepancies and make updates as necessary
  • Identify issues, determine impact to risk adjustment models and reports results for various products and services
  • Analyze claims data to identify diagnosis codes, within the risk adjustment model, to provide risk or opportunity to the completeness and accuracy of risk adjustment data
  • Serve as risk adjustment coding subject matter expert for Medicare, Medicaid, Marketplace, health plans and corporate Risk Adjustment/Quality Improvement outreach operations team
  • Assist with the documentation of coding-related departmental policies and procedures, both general and specific to all risk adjusted lines of business

 

Required Qualifications

Education/Experience: High school diploma or equivalent and 4+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate’s degree in health related field and 3+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry. Experience with various risk adjustment methodology and chart audits.

Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA or CPMA required.

Education Qualifications

Education/Experience: High school diploma or equivalent and 4+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate’s degree in health related field and 3+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry. Experience with various risk adjustment methodology and chart audits.

Instructions for Resume Submission

Apply to this position at jobs.centene.com

Req# 1130558

Apply Online: http://jobs.centene.com

Posted: March 7, 2019 at 4:31 PM
Post ID: 37227

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