Sr Certified Medical Coder RN

Fidelis Care - New York; Michigan; Remote; USD 68,000 - 124,000; Full time

Job summary

A leading health care organization is seeking a Sr Certified Medical Coder RN to enhance coding processes and ensure compliance with ICD-10 regulations. This role involves analyzing health care information, performing medical records review, and requires a valid RN degree along with coding certifications. The position offers a competitive salary range from $68,700 to $123,700 annually along with a comprehensive benefits package.

Benefits

Health insurance

401K

Tuition reimbursement

Paid time off

Qualifications

• 1 year experience preferred in hospital inpatient coding.
• Nursing experience in managed care organization or acute care hospital required.

Responsibilities

• Establish processes to respond to ICD-10 coding changes affecting claims payment.
• Analyze complex health care information and review medical records.
• Ensure compliance with medical coding rules and regulations.

Skills

ICD-10 coding

Chart review

Health care information analysis

Medical coding compliance

Cross-department collaboration

Education

RN Degree

Valid/Current CPC Certification

Job description

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You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be willing to travel to NYC twice a year for required meetings.

Position Purpose

The focus of this position is to establish processes to respond to ICD-10 coding changes and their effect on inpatient claims payment. Chart review will include DRG pre-payment review, hospital readmission review, and outlier payment review.

• Analyze moderately complex health care information; review medical records; integrate medical coding and reimbursement rules; provide pricing guidance.
• Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues.
• Provide regular reports on project status and progress; report project results to identify coding improvement opportunities.
• Collaborate with other business units to identify and implement process efficiency and quality improvement practices.
• Work with IT resources to implement system efficiencies and configuration enhancements to improve claims processing operations.
• Apply Coding Guidelines as described in the ICD-10 Coding Manual.
• Performs other duties as assigned.
• Comply with all policies and standards.

Education/Experience

RN Degree. One year experience preferred in hospital inpatient coding. Nursing experience in managed care organization or acute care hospital.

For Fidelis Care only: One year of experience in a clinical setting or acute care hospital; RN, PA, MD, APRN, DO or MBBS license required. Coding Credential Required: Valid/Current CPC Certification, through APPC preferred or CIC through AAPC or CCS through AHIMA; RHIA/RHIT Credentials-Preferred.

Pay Range $68,700.00 - $123,700.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional incentives.

Centene is an equal opportunity employer that values diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristic.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Seniority level

• Not Applicable

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care
• Insurance