Remote Medical Coding Reviewer I

Centene Corporation; Missouri; Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a qualified clinical/coding medical claims reviewer to ensure billing compliance and accurate coding through comprehensive review of claims, records, and guidelines.

The role involves collaborating with Medical Directors, researching coding questions, and flagging cases for prepayment reviews when appropriate, with a strong emphasis on accuracy and policy adherence.

Qualifications

• Associate degree or equivalent experience; coding certification preferred.
• 2+ years in medical billing and coding, coding/data analysis, or related clinical experience.
• Licensure/certification options include LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic.

Responsibilities

• Analyze provider billing practices using code auditing software and regulatory codes.
• Review medical records for coding consistency and for appeals/adjustments.
• Consult with Medical Director to validate decisions and identify policy gaps.
• Research health plan coding questions as needed.
• Identify potential billing errors, abuse, and fraud.
• Flag cases for prepayment review when appropriate.
• Maintain records and documentation.
• Perform other duties as assigned.
• Comply with all policies and standards.

Skills

Billing analysis

Medical records review

Regulatory compliance

Fraud detection

Prepayment review

Education

Associate’s degree

Coding certification

RN/LPN

Tools

Code auditing software

Job description

Centene Corporation seeks a qualified clinical/coding medical claims reviewer to ensure billing compliance and accurate coding through comprehensive review of claims, records, and guidelines.

The role involves collaborating with Medical Directors, researching coding questions, and flagging cases for prepayment reviews when appropriate, with a strong emphasis on accuracy and policy adherence.