Centene Corporation
Healthcare Insurance • Non-profit • Social Impact
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Senior Risk Adjustment Coding Compliance Analyst, Clinical
October 28
Centene Corporation
Healthcare Insurance • Non-profit • Social Impact
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
📋 Description
• Executes Line 2 oversight of Risk Adjustment activities • Reviews medical records to assess proper extraction of medical diagnoses • Identifies and evaluates clinical documentation gaps, assesses risk levels • Collaborates with coding teams to improve documentation practices • Ensure coding accuracy by reviewing inpatient and outpatient medical records • Validate clinical documentation to support appropriate risk adjustment coding • Implement CMS risk adjustment guideline oversight • Conduct Line 1 gap analyses and provide clinical best practice recommendations • Provide expert guidance on CMS coding requirements, clinical documentation improvement (CDI) • Evaluate policies and procedures to ensure completeness, clinical accuracy, and adherence to current regulatory requirements
🎯 Requirements
• High School Diploma or GED required • Bachelor's Degree Nursing, Healthcare Management, Business Management or related field preferred • 5+ years professional coding experience in a hospital or physician setting required • Experience in Managed care preferred • LVN, LPN or RN required • Certified Professional Coder (CPC) required • NP or PAN preferred • Certified Coding Specialist (CCS) preferred
🏖️ Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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