At WellCare, we are a passionate team with a strong mission and a focused purpose: to serve our members and local communities in which they live while helping them lead better, healthier lives. Our culture is one of empowerment, teamwork and commitment as we all work together to deliver cost:effective solutions that create positive outcomes for our members. Join us in a career that inspires passion and purpose across all levels and disciplines within our award:winning organization.
Location: (Houston, Texas) Department: ACO
Reports to: Manager, Risk Adjustment Audit Programs
Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level.
Subject matter experts for proper risk adjustment coding and CMS data validation Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met. Analyze MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers. Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc. Works on additional risk adjustment audit requests (ie outside auditors requests). Serves on the RADV Committee as subject matter experts. Perform quality assurance auditing (ie ensure appropriateness and accuracy of ICD:9/ICD:10 coding) for WellCares Medical Coding Specialists. Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re:training topics. Perform other duties as necessary. Additional Responsibilities:
Candidate Education: Required A High School or GED Preferred An Associates Degree in Health Information, Health Administration or other relevant field Candidate Experience: Required 5 years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder Required 2 years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred Preferred Other managed care experience Candidate Skills: Advanced Demonstrated interpersonal/verbal communication skills Advanced Demonstrated written communication skills Advanced Ability to represent the company with external constituents Advanced Knowledge of medical terminology and/or experience with CPT and ICD:10 coding Advanced Other Proficient in public speaking, presentations, and educational activities Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Intermediate Demonstrated written communication skills Intermediate Demonstrated organizational skills Intermediate Ability to work as part of a team Intermediate Ability to work independently Licenses and Certifications:
A license in one of the following is required:
Required Other One of the following certifications are required at the time of hire: CPC or CCS Required Other CPMA is required within the first year of employment Required Other CRC required on the second year of employment Technical Skills: Required Intermediate Microsoft Outlook Required Intermediate Microsoft Excel Required Intermediate Microsoft Visio Required Intermediate Microsoft Word Required Intermediate Microsoft PowerPoint Languages:
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing go
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