Remote Medical Coding Auditor | Claims Review & Compliance

Centene Corporation; Florida; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work options

Job summary

Centene Corporation is seeking a clinical/coding medical claim reviewer to ensure compliance with coding practices by analyzing medical claims, records, and regulatory guidelines including AMA and CMS criteria.

The role requires an Associate’s degree or equivalent experience, plus coding certification and 2+ years in medical billing/coding or related clinical data management. Remote, hybrid, or office work options are available.

Qualifications

• Associate’s degree or equivalent experience.
• Coding certification plus 2+ years in medical billing & coding or related clinical data management.

Responsibilities

• Analyze provider billing practices using code auditing software and policies.
• Review medical records to ensure billing aligns with clinical documentation for appeals and code reviews.
• Consult with Medical Director to validate decisions and identify policy gaps.
• Assist with research of health plan coding questions and potential prepayment reviews.
• Identify billing errors, potential fraud, and opportunities for education with providers.
• Maintain documentation and records, and comply with company policies.

Skills

Code auditing

Medical coding

Claims analysis

Education

Associate’s degree

Coding certification

Tools

Coding software

Job description

Centene Corporation is seeking a clinical/coding medical claim reviewer to ensure compliance with coding practices by analyzing medical claims, records, and regulatory guidelines including AMA and CMS criteria.

The role requires an Associate’s degree or equivalent experience, plus coding certification and 2+ years in medical billing/coding or related clinical data management. Remote, hybrid, or office work options are available.