Remote Coding Quality Analyst - DRG/ICD-10 Expert

Centene Corporation; Clifton (TX); On-site; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation on inpatient and outpatient records. You will validate the accuracy of diagnostic and procedural coding, determine payment methodology, and prepare written rationales for providers and review teams.

In this journey-level role, you will stay current with Coding Clinic updates, participate in in-service education, and identify patterns of fraud or abuse while ensuring compliance with

Qualifications

• Two years experience with DRG, ICD-9-CM/ ICD-10-CM/PCS, CPT, HCPCS coding.

Responsibilities

• Performs complex review of physician clinical documentation on inpatient and outpatient medical records.
• Performs quality analysis to determine accuracy of diagnostic and procedural coding, the correct interpretation and application of official coding guidelines and rules, and assignment of appropriate codes.
• Determines correct payment methodology and reimbursement.
• Develops case-specific written rationale to substantiate and communicate findings to hospital, provider, medical director, and peer review team.
• Conducts coding re-review for decisions that are based on coding convention and sequencing guidelines, not requiring medical review.
• Identifies clinical questions and refers cases to Medical Director.
• Responds to providers for resolution of appeals.
• Reviews updates to Coding Clinics, coding newsletters, and other professional resources to maintain up-to-date knowledge.
• Participates in ongoing in-service programs for coding-related or clinical education.
• Identifies and interprets patterns of possible fraud or abuse and refers to appropriate party for further evaluation and corrective action.
• Conducts periodic peer reviews.
• Other duties as assigned.

Skills

Coding quality

Clinical documentation

Medical coding

Quality analysis

Education

AA, Health Information Technology preferred

Job description

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation on inpatient and outpatient records. You will validate the accuracy of diagnostic and procedural coding, determine payment methodology, and prepare written rationales for providers and review teams.

In this journey-level role, you will stay current with Coding Clinic updates, participate in in-service education, and identify patterns of fraud or abuse while ensuring compliance with