Clinical Policy Coding Analyst — Remote/Hybrid

Centene Corporation; Indiana (PA); Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Coding Policy Specialist to support Clinical Policy and Claims Edit Guidelines, ensuring medical necessity reviews and proper coding for authorizations.

You will collaborate with Medical Management and cross-functional teams to update policies, perform regulatory research, and oversee vendor interactions while maintaining compliance and accuracy across departments.

Qualifications

• Associate's degree in a related field or equivalent experience.
• 4+ years of experience in medical coding.
• License in RHIA, RHIT, CCS, CCS-P, or CPC/CPC-H.

Responsibilities

• Review and update Clinical Coverage Guidelines (CCGs) and Claims Edit Guidelines (CEGs) to support medical necessity reviews.
• Research state and federal regulations and coding guidelines.
• Coordinate with Medical Management and vendors on coding reviews and policy implementations.

Education

Associate's degree or equivalent

Job description

Centene Corporation seeks a Coding Policy Specialist to support Clinical Policy and Claims Edit Guidelines, ensuring medical necessity reviews and proper coding for authorizations.

You will collaborate with Medical Management and cross-functional teams to update policies, perform regulatory research, and oversee vendor interactions while maintaining compliance and accuracy across departments.