Risk Adjustment Specialist (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.
 

Qualified candidates must reside in the state of Pennsylvania*

Position Purpose: Purpose of job is to engage and educate providers on accurate capture and reporting chronic conditions for revenue management purposes and ensure program is following state and federal guidelines while doing so. Main function is provider engagement, training, data analysis and reporting. Position is responsible for outreach and engagement to 60-100 providers with sole responsibility of engaging, training, providing monthly reporting and using data to develop strategies and best practices that will help providers earn incentives and increase revenue for company by accurately capturing and documenting chronic conditions. Position is responsible for ensuring medical records are received and working with vendors to overcome barriers and ensure providers are compliant with mandated audits and medical record requests.

• Outreach to providers (phone, email, zoom meetings) to educate on projects and requirements to earn incentives and be compliant with health plan asks and serve as point of contact for questions, reports, issues throughout life of projects.

• Use Excel and Internal Tools to develop reporting detailing engagement, issues, progress, to ensure providers are on track to meet goals.

• Review and analyze data from projects to identify barriers and develop strategies and best practices to help providers be successful in project.

• Use professional oral and written communication skills to communicate with providers via email, zoom meetings, on the phone to educate, provide updates, train, and serve as a resource for providers to increase engagement in projects.

• Use various vendor portals to identify barriers that are keeping health plan from receiving medical records for risk adjustment purposes. Research provider information using internal systems and internet, Outreach to provider offices, share best practices help reach goals set by Corporate to get medical records in for coding and abstraction.

Education/Experience: High School Diploma / GED. 2 years of Health Insurance, Customer Service, Claims, or Provider Office experience required. Health Insurance experience preferred.

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