Remote Behavioral Health Investigator & Coding Auditor

Centene Management Company LLC; Missouri; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/work schedules

Job summary

Centene Management Company LLC is seeking a remote credentialed reviewer to conduct comprehensive medical record audits across providers, suppliers, and pharmacies. You will verify services against claims, ensure coding accuracy and medical necessity, and support the Special Investigations Unit with findings and recommendations.

The role requires a Master’s Degree with 2+ years of clinical experience and an active behavioral health license; auditing and coding background is preferred.

Qualifications

• Master’s Degree plus 2+ years of relevant clinical experience with an independent license.
• Active behavioral health license required.
• Experience in utilization management, auditing, coding and fraud detection preferred.
• Experience in provider education and managed care organizations preferred.

Responsibilities

• Perform retrospective and prepayment reviews of medical records to identify fraud, waste and abuse.
• Investigate provider billing patterns to determine payment based on medical records and policies.
• Prepare summaries of findings and recommend next steps for providers.
• Collaborate with investigators and communicate results in meetings or hearings.
• Support SIU investigators during interviews and negotiations with providers, suppliers and pharmacies.

Skills

Utilization management

Auditing

Coding

Fraud awareness

Education

Master’s Degree

Behavioral health license (LMHC/LCSW/LMFT/LPC/LMHP/LIMHP)

Job description

Centene Management Company LLC is seeking a remote credentialed reviewer to conduct comprehensive medical record audits across providers, suppliers, and pharmacies. You will verify services against claims, ensure coding accuracy and medical necessity, and support the Special Investigations Unit with findings and recommendations.

The role requires a Master’s Degree with 2+ years of clinical experience and an active behavioral health license; auditing and coding background is preferred.