Coding Quality Specialist

Job not on LinkedIn

🔥 12 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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

• Performs complex reviews of physician clinical documentation on inpatient and outpatient medical records • Performs quality analysis to validate diagnostic and procedural coding and the application of official coding guidelines and rules • Determines correct payment methodology and reimbursement • Develops case-specific written rationale to substantiate and communicate findings to hospitals, providers, medical directors, and peer review teams • Conducts coding re-review for decisions based on coding convention and sequencing guidelines • Identifies clinical questions and refers cases to Medical Director • Responds to providers for resolution of appeals • Reviews updates to Coding Clinics, coding newsletters, and other professional resources • Participates in ongoing in-service programs for coding-related or clinical education • Identifies and interprets patterns of possible fraud or abuse and refers them for further evaluation and corrective action • Conducts periodic peer reviews • Complies with all policies and standards • Performs other duties as assigned

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • AA in Health Information Technology preferred • Two years experience with Diagnosis Related Groups (DRG), ICD-9-CM/ICD-10-CM/PCS, CPT, and HCPCS coding • One or more of the following certifications may be required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC) • Up-to-date knowledge of Coding Clinics, coding newsletters, and other professional resources

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity