Remote Coding Quality Specialist: DRG & ICD Expert

Centene Corporation; Austin (TX); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene, a leading healthcare enterprise, seeks a Coding Quality Coordinator II to perform complex reviews of clinical documentation on inpatient and outpatient medical records. You will validate diagnostic and procedural coding accuracy, determine payment methodology, and develop written rationales for reviewer teams and providers.

Ideal candidates have an AA in Health Information Technology and 2+ years of DRG/ICD-9-CM/ICD-10-CM/PCS coding experience, with relevant certifications such as

Qualifications

• Complex reviews of physician clinical documentation for inpatient and outpatient records.
• Quality analysis to ensure correct diagnostic/procedural coding and coding guidelines.
• Submit case-specific rationale to substantiate findings to hospitals, providers and review teams.

Responsibilities

• Performs complex review of physician clinical documentation on inpatient and outpatient medical records.
• Determines correct payment methodology and reimbursement.
• Develops case-specific written rationale to communicate findings to hospital, provider, medical director and peer review team.
• Responds to providers for resolution of appeals.
• Keeps up to date with Coding Clinics, coding newsletters and other professional resources.

Skills

Clinical documentation review

Medical coding accuracy

Payment methodology

Provider communication

Fraud detection

Education

AA in Health Information Technology

RHIA/RHIT/CCS/CCA/CPC certifications

Job description

Centene, a leading healthcare enterprise, seeks a Coding Quality Coordinator II to perform complex reviews of clinical documentation on inpatient and outpatient medical records. You will validate diagnostic and procedural coding accuracy, determine payment methodology, and develop written rationales for reviewer teams and providers.

Ideal candidates have an AA in Health Information Technology and 2+ years of DRG/ICD-9-CM/ICD-10-CM/PCS coding experience, with relevant certifications such as