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Risk Adjustment Audit/Education/Training Consultant - 132349SK in Mason, OH at Anthem, Inc.

Date Posted: 3/14/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. 


Mason, OH

Miamisburg, OH

Worthington, OH

Cincinnati, OH

Richmond, VA

Virginia Beach, VA

Indianapolis, IN

Chicago, IL

Atlanta, GA

Other Anthem offices may be considered

Job Summary:

Responsible for ensuring complete risk scores and accurate revenue and mitigating payment error risk via auditing, education, and training for proper diagnosis coding and documentation practices.

Primary duties may include, but are not limited to:

  1. Identifies opportunities to improve accuracy and completeness for revenue impact.
  2. Translates data to provide answers for provider consultations in order to improve medical record documentation and risk scores.
  3. Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
  4. Develops and implements action plans to address issues identified through data analysis.
  5. Provides oversight, guidance, and training to partner providers and clinicians related to CMS guidelines and HCC best practices.
  6. Develops training programs and tools; performs internal process and policy audits.

Job Requirements

  • Requires BA/BS in health sciences, health management, or nursing.
  • 6 years of experience in healthcare including provider relationship management, ICD-9/ICD-10 coding, and experience in a consultative role, including 3 years of CMS Risk Adjustment experience.
  • Any combination of education and experience, which would provide an equivalent background.
  • Excellent written and verbal communication skills required.
  • Displaying professionalism while representing Anthem.
  • Teaching or instructor experience preferred.
  • Experience working with MS Office (Proficient level with PowerPoint, Excel and Word / Familiarity with Access) required.
  • Coding certification to include either:  CPC, CCS, CCS-P, or other recognized coding certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.
  • CRC is a plus.
  • Experience developing training programs and provider tools required.
  • Proficiency in programming, query and/or data analysis tools/software preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.