Medical Coding Reviewer I

Centene Corporation; Kansas; Remote; Full time

Job summary

Join a leading organization in health services as a Medical Coding Specialist. You will ensure compliance in coding practices, conduct thorough reviews of medical claims, and work flexibly in a remote position. The ideal candidate should possess relevant certifications and have prior billing experience to help optimize billing operations across the board.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Schedule

Qualifications

• 2+ years of experience in medical billing & coding.
• Experience in provider communication and education preferred.
• Licenses such as LPN, RN, CPC, or similar required.

Responsibilities

• Perform clinical review of medical claims for compliance.
• Analyze billing practices and identify potential errors.
• Collaborate with Medical Director on coding decisions.

Skills

Coding Certification

Medical Billing

Data Analysis

Education

Associate’s Degree in related field

Job description

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***
• IDEAL CANDIDATE WILL HAVE CODING CERTIFICATION***
  
  

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.

• Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion
• Review medical records to ensure billing is consistent with medical record for appeals, adjustments and miscellaneous/unlisted code review
• Review cases with Medical Director to validate decisions and identify opportunities to create medical policy in the absence of guidelines
• Assist with research of health plan coding questions
• Identify potential billing errors, abuse, and fraud
• Identify opportunities to flag potential cases which may warrant a prepayment review (versus an automatic system denial or payment)
• Maintain appropriate records, files, documentation, etc
• Performs other duties as assigned
• Complies with all policies and standards
  
  

Education/Experience Associate’s degree in related field or equivalent experience. Coding certification and 2+ years of experience in medical billing & coding, coding/data analysis, accounting/business or physician/hospital data management or RN/LPN and 2+ years of related clinical experience. Experience in provider communication and education preferred.

License/Certification LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or ParamedicPay Range $26.50 - $47.59 per hour

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Insurance

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