Remote Medical Coding & Claims Review Specialist

Centene Management Company LLC; United States; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401k

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC seeks a clinical/coding claims reviewer to ensure coding compliance across medical records and billing data. You will analyze claims, records, and guidelines, applying AMA and CMS criteria to support accurate reimbursements.

The role requires an Associate's degree with 2+ years of coding/billing experience and relevant certifications. Remote, hybrid, or office work options are available, with a comprehensive benefits package.

Qualifications

• Associate's degree or equivalent experience.
• Coding certification and 2+ years of medical billing & coding experience.
• Experience in provider communication and education preferred.

Responsibilities

• Perform clinical/coding medical claim review for compliance with coding practices.
• Analyze medical records, claims history, and guidelines per AMA/CMS.
• Review cases with Medical Director to validate decisions and policy gaps.
• Research coding questions and flag potential errors, abuse or fraud.
• Maintain records and comply with policies and standards.

Skills

Medical coding

Auditing

Regulatory knowledge

Communication

Education

Associate's degree or equivalent

Tools

Code auditing software

Job description

Centene Management Company LLC seeks a clinical/coding claims reviewer to ensure coding compliance across medical records and billing data. You will analyze claims, records, and guidelines, applying AMA and CMS criteria to support accurate reimbursements.

The role requires an Associate's degree with 2+ years of coding/billing experience and relevant certifications. Remote, hybrid, or office work options are available, with a comprehensive benefits package.