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Centene Corporation · 7 hours ago

Senior Risk Adjustment Coding Compliance Analyst (Clinical)

United States

Full-time

Remote

Mid, Senior Level

$69K/yr - $124K/yr

5+ years exp

Centene Corporation is transforming the health of communities across the United States. The Senior Risk Adjustment Coding Compliance Analyst is responsible for overseeing risk adjustment activities, ensuring coding accuracy, and collaborating with coding teams to improve documentation practices and compliance with regulatory guidelines.

Hospital & Health Care

Responsibilities

Ensure coding accuracy by reviewing inpatient and outpatient medical records using clinical expertise to interpret documentation in accordance with ICD-10, Coding Clinic, AHIMA, and company coding guidelines

Validate clinical documentation to support appropriate risk adjustment coding, including Hierarchical Condition Categories (HCCs), with emphasis on clinical relevance and site of coding clinical appropriateness

Apply ICD-10, AHIMA standards, Coding Clinic guidance, and company policies to ensure accurate and compliant coding practices, incorporating clinical judgment to assess documentation sufficiency

Implement CMS risk adjustment guideline oversight and evaluate clinical documentation to ensure alignment with regulatory standards and coding compliance

Review and appropriately challenge coding decisions based on clinical interpretation of documentation, current industry guidelines, audit findings, and regulatory requirements

Conduct Line 1 gap analyses and provide clinical best practice recommendations; design and execute Line 2 oversight to evaluate the effectiveness and compliance of risk adjustment quality programs

Provide expert guidance on CMS coding requirements, clinical documentation improvement (CDI), and industry best practices to coding teams and providers

Assess risk levels in coding data using clinical insight and recommend mitigation strategies to address potential compliance or reimbursement risks

Support remediation efforts for identified non-compliance issues by applying clinical knowledge to root cause analysis and corrective action planning

Evaluate policies and procedures to ensure completeness, clinical accuracy, and adherence to current regulatory requirements and best practices

Perform clinical chart reviews and advise on clinical best practices related to risk adjustment coding, HCC capture, and documentation improvement

Performs other duties as assigned

Complies with all policies and standards

Qualification

ICD-10 codingCertified Professional Coder (CPC)Certified Coding Specialist (CCS)Clinical documentation improvementRisk adjustment codingClinical judgmentAnalytical skillsCommunication skillsTeam collaboration