Remote Coding Quality Coordinator II

Centene Corporation; Town of Texas (WI); Hybrid; 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 in inpatient and outpatient records, ensuring accurate coding and appropriate reimbursement. You will develop written rationales and respond to providers regarding appeals, while staying current with coding guidelines.

The role requires knowledge of DRG, ICD-9/ICD-10, CPT, and HCPCS coding with several years of experience.

Qualifications

• AA in Health Information Technology preferred.
• Two years of 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 and reimbursement.
• Develops case-specific written rationale to communicate findings to hospital, providers, and peers.
• Responds to providers for resolution of appeals.
• Identifies and interprets patterns of possible fraud or abuse and refers for further action.
• Reviews coding updates to stay current with official guidelines.
• Participates in in-service coding-related education and other duties as assigned.

Skills

Clinical documentation review

Healthcare coding knowledge

Communication with providers

Quality analysis

Regulatory awareness

Education

AA in Health Information Technology

Tools

ICD-9-CM/ICD-10-CM/PCS

CPT/HCPCS coding

Job description

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation in inpatient and outpatient records, ensuring accurate coding and appropriate reimbursement. You will develop written rationales and respond to providers regarding appeals, while staying current with coding guidelines.

The role requires knowledge of DRG, ICD-9/ICD-10, CPT, and HCPCS coding with several years of experience.