Medical Coding Reviewer I

Centene Corporation; Orlando (FL); Remote; Full time

Job summary

A leading healthcare organization is seeking a Medical Coding Reviewer I to ensure compliance with coding practices and perform thorough reviews of medical claims. This remote position requires strong analytical skills and a background in medical billing and coding. Join a diverse team committed to improving healthcare for millions of members while enjoying competitive benefits and flexible work arrangements.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Holidays

Flexible Work Arrangements

Qualifications

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

Responsibilities

• Analyze provider billing practices using code auditing software.
• Review medical records for billing consistency.
• Collaborate with Medical Director for policy development.

Skills

Clinical Analysis

Coding Compliance

Data Analysis

Education

Associate’s degree in a related field

Job description

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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 Details:

• 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, and AMA and CMS code edit criteria.
• Review medical records to ensure billing is consistent with medical records for appeals, adjustments, and miscellaneous/unlisted code review.
• Collaborate with Medical Director to validate decisions and identify opportunities for medical policy development in the absence of guidelines.
• Research health plan coding questions.
• Identify potential billing errors, abuse, and fraud.
• Flag cases that may require prepayment review.
• Maintain records, files, and documentation.
• 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 in medical billing & coding, data analysis, or related clinical experience. Experience in provider communication and education is preferred.

License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic.

Pay Range: $26.50 - $47.59 per hour.

Centene offers comprehensive benefits including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay will be based on skills, experience, and other factors. Total compensation may include incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to 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.