Remote Clinical Billing Auditor

Centene Corporation; United States; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking an Auditor to review medical records and identify inappropriate billing practices through claims data, medical records, and policy reviews. You will investigate provider billing patterns, prepare summaries, and recommend actions to improve internal controls.

Preferred qualifications include coding certification and CPT coding experience; nurse coding background is a plus. The role offers flexible work arrangements with remote, hybrid, or field options, and

Qualifications

• 2+ years of related clinical experience in medical auditing.
• Coding certification from an accredited organization required.
• Experience with CPT coding preferred.

Responsibilities

• Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices
• Investigate, analyze, and identify provider billing patterns to recommend payment based on medical records and CPT codes
• Prepare summary of findings and recommend next steps for providers
• Identify preventative measures and suggest changes to internal policies and procedures
• Consult investigators to identify abuse and fraud using clinical and coding expertise
• Performs other duties as assigned.
• Complies with all policies and standards.

Education

Associate’s Degree or equivalent

Job description

Centene Corporation is seeking an Auditor to review medical records and identify inappropriate billing practices through claims data, medical records, and policy reviews. You will investigate provider billing patterns, prepare summaries, and recommend actions to improve internal controls.

Preferred qualifications include coding certification and CPT coding experience; nurse coding background is a plus. The role offers flexible work arrangements with remote, hybrid, or field options, and