Clinical Coding Quality Analyst - Remote

Centene Corporation; United States; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation and validate diagnostic and procedural coding across inpatient and outpatient records. The role ensures proper payment methodology and prepares written rationales for appeals to providers and medical leadership.

The position emphasizes staying current with Coding Clinics and related resources, contributing to ongoing coding education, and conducting peer reviews as part of a

Qualifications

• Validates accuracy of diagnostic and procedural coding.
• Determines correct payment methodology and reimbursement.
• Develops case-specific written rationale to substantiate findings.
• Responds to providers for resolution of appeals.
• Reviews updates to Coding Clinics and coding resources to stay current.

Responsibilities

• Performs complex review of physician clinical documentation on inpatient and outpatient medical records.
• Performs quality analysis to determine accuracy of coding and interpretation of official coding guidelines.
• Identifies patterns of possible fraud or abuse and refers for corrective action.
• Conducts periodic peer reviews.
• Other duties as assigned.

Education

AA, Health Information Technology

RHIA

RHIT

CCS

CCA

CPC

Tools

DRG Coding Systems

ICD-9-CM/ICD-10-CM/PCS

CPT/HCPCS coding

Job description

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation and validate diagnostic and procedural coding across inpatient and outpatient records. The role ensures proper payment methodology and prepares written rationales for appeals to providers and medical leadership.

The position emphasizes staying current with Coding Clinics and related resources, contributing to ongoing coding education, and conducting peer reviews as part of a