Medical-- What do they do at WellPoint?

Become part of the force that is propelling WellPoint toward our goal of improving health outcomes and quality of life for our associates, members and communities.
Become part of the force that is propelling WellPoint toward our goal of improving health outcomes and quality of life for our associates, members and communities. Create and share advanced educational tools that empower individuals to take ownership of their health and wellness. Build upon your diverse clinical skills and experience, while enjoying opportunities for advancement and a more balanced way of life.

Medical professionals at WellPoint:
  • Work independently as well as collaboratively within our team of exceptional nurses, physicians and pharmacists
  • Support the Company's various business units in the development of innovative benefit designs that promote transparency, stability and affordability
  • Show initiative and make key decisions with the potential to dramatically influence patient outcomes and positively impact peoples' lives
  • Ensure members get the support they need before, during and after their medical procedures, while helping to maintain exceptional quality control at every stage of the member relationship cycle

    Physician Executive Fellowship
Coding Auditor- (Cerritos, CA) -87377
CA , Cerritos
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Job Post Date:   
WellPoint, Inc
Job Description

CareMore is a proud member of the WellPoint family of companies.  As a leading healthcare system specializing in providing a complete, pro-active health care experience to Senior Americans, our vision is to significantly improve the lives of Medicare recipients by employing a dedicated staff of professionals who are passionate about changing lives.   At CareMore, we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.
Position Summary:



Responsible for auditing Medicare Advantage diagnosis data collected from physician and hospital medical records to ensure proper ICD9 coding and compliance with risk adjustment requirements.


Primary duties may include, but are not limited to:


  • Audits Medicare Advantage diagnosis data retrieved from physician and hospital medical records and/or data extract files for both revenue project and RADV.
  • Assists with CMS National and Targeted Risk Adjustment Data Validation audits.
  • Performs QC of Coding Analysts work on a bi-annually basis.
  • Provides regular feedback to manager on performance improvement opportunities as a result of audits.
  • Assesses and identifies training opportunities.
  • Maintains current knowledge of requirements and guidance required in the performance of audit duties.

Job Qualifications


Requires a high school diploma; 1 year of experience as a coder of medical records in a physician office, hospital, or insurance/coding office setting and HCC experience; or any combination of education and experience, which would provide an equivalent background.

BS in health sciences, health management or related field preferred.

Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required. Experience working with Medicare Advantage preferred.

Experience with ICD-9 coding a plus. Willing to travel occassionally to offsite locations or to expansion markets; required.



Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).

*Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

*WARNING :  Please beware of phishing scams that promote work-at-home opportunities and may also pose as legitimate companies. Please be advised that a WellPoint recruiter will never ask you for a credit card or any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application on our web site.

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