Remote Coding Quality Specialist

Centene Corporation; Texas; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work with remote, hybrid, or

Job summary

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation for inpatient and outpatient records, validating coding accuracy, payment methods, and reimbursement amounts. The role requires developing written rationales and communicating findings to hospital staff, medical directors, and peer review teams.

Responsibilities include coding re-reviews, identifying questions for Medical Director, and staying current with Coding Clinics and

Qualifications

• AA in Health Information Technology preferred.
• 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 records.
• Determines correct payment methodology and reimbursement.
• Develops case-specific written rationale to substantiate findings and communicates to hospital, providers, and review teams.
• Responds to providers for resolution of appeals.
• Keeps up-to-date with Coding Clinics and coding resources.

Skills

DRG coding

ICD-10-CM/PCS

CPT/HCPCS coding

Quality analysis

Education

AA, Health Information Technology

Job description

Centene Corporation is seeking a Coding Quality Coordinator II to perform complex reviews of clinical documentation for inpatient and outpatient records, validating coding accuracy, payment methods, and reimbursement amounts. The role requires developing written rationales and communicating findings to hospital staff, medical directors, and peer review teams.

Responsibilities include coding re-reviews, identifying questions for Medical Director, and staying current with Coding Clinics and