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