Centene Corporation Lead Risk Adjustment Coding Analyst in Clayton, Missouri

ProfessionalPosition 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.

  • Review and analyze results of risk adjustment coding validation across multiple states to identify coding patterns, recommend general and specific provider education topics, and develop communication

  • Identify issues, determine impact to risk adjustment models and reports results for various products and services

  • Review and 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

  • Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records

  • Collaborate with vendor on data extraction and disputes

  • Serve as risk adjustment coding subject matter expert for all Medicare, Medicaid, Marketplace, health plans and corporate Risk Adjustment/Quality Improvement outreach operations team

  • Develop and document coding-related departmental policies and procedures, both general and specific to all risk adjusted lines of business

  • Serve as the go to person for other team members and assist them with complex issues

Education/Experience: High school diploma or equivalent and 6+ 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 5+ 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.

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.

TITLE: Lead Risk Adjustment Coding Analyst

LOCATION: Clayton, Missouri

REQNUMBER: 1103436

COMPANY: Health Insurance Operations

POSITION TYPE: Professional