Risk Adjustment Specialist II - (non-clinical)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Applicants for this job have the flexibility to work remote from home. Candidate must in the state of Arizona and be willing to travel to areas surrounding Tempe and Tucson, Arizona.

Position Purpose: Utilize risk adjustment methodologies, principles, and knowledge of managed care organizations to increase engagement in provider performance programs utilizing data to develop strategies and best practices. This position will be responsible for driving provider performance by facilitating provider education trainings on systems and programs. The position is responsible for using ICD10 coding and claims knowledge to support improvement of coding and medical record documentation of risk adjusted conditions. Position will be responsible for oversight and engagement of 70-100 providers.

• Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies.
• Use knowledge of ICD10 guidelines to develop trainings and coding materials that will enhance providers and staff engagement in coding and documentation initiatives.
• Use advanced Excel data and reporting skills to identify Risk Adjustment trends, barriers and develop strategies and best practices for engagement.
• Collaborate within health plan to develop newsletters and facilitate provider webinars and trainings.
• Apply clinical coding knowledge to review claims and medical records for appropriate documentation and coding.
• Rely upon independent critical thinking and decision making skills to assist providers with inquiries and barriers.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Bachelor's Degree in Health Promotion, Public Health, Health Administration, Business Administration or related field required: 3+ years equivalent experience in Health Insurance, Customer Service, Claims, or Provider Office required: Knowledge of healthcare, managed care, and Risk adjustment methodologies is highly preferred. 10% in-state travel required.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act