Remote Licensed Clinical Coding Analyst — Policy & Guidelines

Centene Corporation; United States; On-site; USD 70,000 - 100,000; Full time

Job summary

Centene Corporation is seeking a full-time Licensed Clinical Coding Analyst to ensure accurate coding for Clinical Coverage Guidelines and Claims Edit Guidelines while working remotely. The role involves guiding updates, researching evidence-based criteria, and coordinating with the Coding Integrity team for final edits.

Ideal candidates have 4+ years in medical coding, familiarity with Medicare/Medicaid rules, and hold RHIA/RHIT/CCS/CCS-P/CPC or CPC-H licensure.

Qualifications

• Associate's Degree or equivalent experience in a related field.
• 4+ years in the medical coding field with facility, provider, or payer exposure.
• Knowledge of Medicare and Medicaid regulations.
• Licensure as RHIA/RHIT/CCS/CCS-P/CPC or CPC-H.

Responsibilities

• Directs review and updates of coding in CCGs to support medical necessity reviews and revisions to CEGs.
• Conducts research on evidence-based criteria and authorization rules to support clinical decision-making.
• Oversees hand-off of CCGs and CEGs to the Coding Integrity team for final review and implementation.

Skills

Medical coding experience

Clinical documentation review

Research and criteria analysis

Education

Associate's Degree in a related field

RHIA

RHIT

CCS

CCS-P

CPC

CPC-H

Job description

Centene Corporation is seeking a full-time Licensed Clinical Coding Analyst to ensure accurate coding for Clinical Coverage Guidelines and Claims Edit Guidelines while working remotely. The role involves guiding updates, researching evidence-based criteria, and coordinating with the Coding Integrity team for final edits.

Ideal candidates have 4+ years in medical coding, familiarity with Medicare/Medicaid rules, and hold RHIA/RHIT/CCS/CCS-P/CPC or CPC-H licensure.