Centene Corporation
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Contracting • Network Development • Managed Care
Risk Adjustment Specialist - Non-clinical
March 26
Centene Corporation
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Contracting • Network Development • Managed Care
📋 Description
• Utilize risk adjustment methodologies, principles, and knowledge of managed care organizations to increase engagement in provider performance programs • Responsible for driving provider performance by facilitating provider education trainings on systems and programs • Responsible for using ICD10 coding and claims knowledge to support improvement of coding and medical record documentation • Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies • 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
🎯 Requirements
• 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 • 10% in-state travel required
🏖️ Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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