Risk Adjustment Auditor – Educator

Centene Corporation

. Conduct provider medical record audits .

Posted 11/3/2026full-timeRemote • Nevada • United StatesMid-LevelSenior💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical coding, particularly in HCC Coding and risk adjustment methodologies, while effectively educating and training providers on compliance with CMS guidelines. Strong analytical skills are applied to audit medical records and coding patterns to ensure quality assurance and adherence to standards.

Highest-signal resume keywords

HCC CodingMedical Record AuditsCPC CertificationRisk Adjustment MethodologyProvider Education

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-9 CodingICD-10 CodingQuality Assurance AuditingData AnalysisDiagnosis Coding Evaluation

Soft Skills

Clear CommunicationStrong Organizational SkillsFlexibility

Certifications & Qualifications

CPCCCSCPMACRC

Industry Keywords

Managed CareCMS ComplianceRisk AdjustmentProvider RelationsMedical Coding Specialists

About the role

Key responsibilities & impact

Conduct provider medical record audits
Analyze practice coding patterns
Provide education and training regarding risk adjustment
Analyze MRA data to identify patterns and develop interventions at provider and market levels
Coordinate an educational work plan for WellCare contracted providers
Work with Provider Relations, Quality, and the state Medical Director to ensure compliance with CMS risk adjustment guidelines
Conduct provider education and training through provider offices, hospitals, webinars, conference calls, and email correspondence
Work on additional risk adjustment audit requests, including outside auditors’ requests
Serve as a subject matter expert on the RADV Committee
Perform quality assurance auditing of ICD-9/ICD-10 coding for WellCare’s Medical Coding Specialists
Communicate QA results and recommend improvement and retraining topics
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor’s degree or equivalent experience required
5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder
2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)
Teaching, Training or an Educator/Instructor role required
CPC or CCS certification required at the time of hire
CPMA required within the first year of employment
CRC required in the second year of employment
Managed Care experience preferred
Strong understanding of HCC methodology, risk-adjustable diagnoses, CMS requirements, and compliant diagnosis capture
Ability to accurately evaluate diagnosis coding and determine whether documentation supports the reported code
Experience working with and educating providers around diagnosis codes
Clear communication, strong organizational skills, and flexibility

Benefits

Comp & perks

Competitive pay
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity