• Analyze medical accounts processed by Arvo's artificial intelligence to validate the accuracy of results. • Conduct detailed audits of items on provider and payer invoices, identifying inconsistencies or correct outputs from the tool. • Provide structured technical feedback to the engineering and data teams, indicating areas for model correction or refinement. • Ensure that the AI validation criteria are aligned with industry best practices in auditing. • Contribute to the continuous training of algorithms by serving as the technical "ground truth" reference in the process.

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. Position Purpose: Conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions at the provider and market level. - Subject matter experts for proper risk adjustment coding and CMS data validation - Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met. - Analyze MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers. - Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. - This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc. - Works on additional risk adjustment audit requests (i.e. outside auditors’ requests). - Serves on the RADV Committee as subject matter experts. - Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists. - Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics. - Perform other duties as necessary. - Additional Responsibilities: - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Bachelor’s degree or equivalent experience required Candidate Experience: 5+ years of experience in a hospital, a physician setting or a Managed Care Organization as a medical coder 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred Preferred Other managed care experience Licenses and Certifications: A license in one of the following is required: One of the following licensures required at hire: CPC or CCS CRC required within the 1st year of employment CPMA preferred on the 2nd year of employment Pay Range: $56,200.00 - $101,000.00 per year 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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

• Working from your home office, this role requires scheduling appointments with the insured to be audited and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards

• Zelfstandig uitvoeren van 25 tot 30 audits per jaar, waarbij je de processen van organisaties monitort op hun CO₂-prestaties. • Toezien op een correcte uitvoering van de audit conform de geldende normen en interne richtlijnen. • Tijdig en helder vastleggen van auditbevindingen in rapportages. • Uitvoeren van kwaliteitscontroles op rapportages van collega’s. • Indien nodig overleggen met collega's omtrent norminterpretaties en uitvoering van audits. • Op de hoogte blijven van de laatste ontwikkelingen binnen de sector en de CO₂ Prestatieladder.