Remote Clinical Policy & Coding Specialist

Managed Health Services (MHS); Indiana (PA); Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene is seeking a skilled Medical Coding Specialist to support Clinical Policy, ensure accuracy of coding in Clinical Coverage Guidelines and Claims Edit Guidelines, and assist in regulatory research. This role partners with Health Services, Medical Management, and external vendors to optimize coding accuracy and compliance.

You will review coding rules, support authorization processes, and respond to complex coding inquiries while upholding CMS guidelines and payer requirements.

Qualifications

• Associate's Degree in a related field is required.
• 4+ years of experience in medical coding within a facility, provider or payer organization.
• Licenses required: RHIA, RHIT, CCS, CCS-P, CPC or CPC-H.

Responsibilities

• Lead initial review of coding in Clinical Coverage Guidelines (CCGs) and update rules.
• Develop and revise Claims Edit Guidelines (CEGs) and new CEGs after research.
• Coordinate with Coding Integrity team to ensure proper edits are implemented.
• Provide regulatory and coding research for MEIs and contractual changes.
• Support Medical Management with complex coding/payment policy inquiries and audits.

Skills

Medical coding

Regulatory knowledge

Research and analysis

Communication skills

Vendor coordination

Education

Associate's Degree in related field

Job description

Centene is seeking a skilled Medical Coding Specialist to support Clinical Policy, ensure accuracy of coding in Clinical Coverage Guidelines and Claims Edit Guidelines, and assist in regulatory research. This role partners with Health Services, Medical Management, and external vendors to optimize coding accuracy and compliance.

You will review coding rules, support authorization processes, and respond to complex coding inquiries while upholding CMS guidelines and payer requirements.