Medical Coding Reviewer I

Job not on LinkedIn

🔥 6 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

👻 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

• Perform clinical/coding medical claim reviews to ensure compliance with coding practices • Analyze medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies, and AMA/CMS guidelines • Analyze provider billing practices using code auditing software and coding criteria • Review medical records for appeals, adjustments, and miscellaneous/unlisted code reviews • Review cases with the Medical Director to validate decisions and identify opportunities for medical policy • Assist with research of health plan coding questions • Identify potential billing errors, abuse, and fraud • Flag potential cases that may warrant prepayment review • Maintain appropriate records, files, and documentation • Perform other assigned duties and comply with policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Associate’s degree in related field or equivalent experience • Coding certification and 2+ years of experience in medical billing & coding, coding/data analysis, accounting/business or physician/hospital data management; or RN/LPN and 2+ years of related clinical experience • One of: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic • Experience in provider communication and education preferred • Knowledge of medical coding practices, AMA and CMS guidelines, regulatory codes, and billing review • Experience using code auditing software • Ability to review medical records, claims history, and provider billing practices

🏖️ Benefits

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