Medical Coding Reviewer I

Centene; Missouri; Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Job summary

Centene is seeking a Medical Coding Reviewer I to perform clinical and coding medical claim reviews ensuring compliance with coding practices. This role fits candidates with medical billing and coding backgrounds who are detail-oriented and analytical.

The position offers remote work options in Missouri with a full-time day shift. You will engage in code auditing, review records for billing consistency, and collaborate with the Medical Director to support policy creation and coding questions.

Qualifications

• 2+ years of experience in medical billing & coding, coding/data analysis, or related clinical experience.
• Associate's degree in related field or equivalent experience.

Responsibilities

• Analyze provider billing practices using code auditing software and regulatory codes.
• Review medical records for consistency with billing for appeals and adjustments.
• Collaborate with the Medical Director to validate decisions and create medical policy.
• Assist with research of health plan coding questions.
• Identify potential billing errors, abuse, and fraud.
• Flag cases for potential prepayment review.
• Maintain appropriate records and documentation.
• Perform other duties as assigned.
• Comply with all policies and standards.

Skills

Medical billing & coding

Data analysis

Regulatory codes

Education

Associate's degree or equivalent experience

Tools

Code auditing software

Job description

About This Role

The Medical Coding Reviewer I position involves performing clinical and coding medical claim reviews to ensure compliance with coding practices. This role is ideal for individuals with a background in medical billing and coding who are detail-oriented and analytical.

Highlights

• Location: Remote, MO
• Schedule: Full Time, Day shift

What You'll Do

• Analyze provider billing practices using code auditing software and regulatory codes
• Review medical records for consistency with billing for appeals and adjustments
• Collaborate with the Medical Director to validate decisions and create medical policy
• Assist with research of health plan coding questions
• Identify potential billing errors, abuse, and fraud
• Flag cases for potential prepayment review
• Maintain appropriate records and documentation
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

Education

• Associate's degree in related field or equivalent experience

Experience

• 2+ years of experience in medical billing & coding, coding/data analysis, or related clinical experience

Licenses & Certifications

• One of the following licenses required: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, supporting individuals, families, and communities through meaningful work.