Medical Coding Reviewer I

Centene Corporation; Kansas; Remote; Full time

Job summary

Join a leading health services organization as a clinical professional, performing medical claim reviews and ensuring compliance with coding practices. This remote position offers flexibility and a comprehensive benefits package, including health insurance and tuition reimbursement.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Options

Qualifications

• 2+ years of experience in medical billing & coding or related clinical experience.
• Experience in provider communication and education is preferred.

Responsibilities

• Perform clinical/coding medical claim review for compliance.
• Analyze provider billing practices using code auditing software.
• Identify potential billing errors, abuse, and fraud.

Skills

Coding

Analysis

Collaboration

Education

Associate’s degree in a related field

Job description

3 days ago Be among the first 25 applicants

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position is REMOTE***

Position Purpose

Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures, and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services.

Responsibilities include:

• Analyze provider billing practices using code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA, and CMS code edit criteria.
• Review medical records to ensure billing aligns with the medical record for appeals, adjustments, and miscellaneous/unlisted code review.
• Collaborate with Medical Director to validate decisions and identify opportunities to create medical policies in the absence of guidelines.
• Assist with research of health plan coding questions.
• Identify potential billing errors, abuse, and fraud.
• Flag potential cases for prepayment review when appropriate.
• Maintain records, files, and documentation accurately.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education/Experience

Associate’s degree in a related field or equivalent experience. Coding certification and 2+ years of experience in medical billing & coding, coding/data analysis, or related clinical experience. Experience in provider communication and education is preferred.

License/Certification

Valid LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic certification.

Pay Range: $26.50 - $47.59 per hour

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work options (remote, hybrid, field, or office).

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Additional Information

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals, Health Care, Insurance