Medical Coding Reviewer I

🔥 1 minute ago

🌵 Arizona, Florida, +1 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

👻 Ghost score 10%

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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 review to ensure compliance with coding practices • Review and analyze medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures, AMA guidelines, and CMS guidelines • Analyze provider billing practices using code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, and AMA/CMS code edit criteria • Review medical records to ensure billing is consistent with medical records for appeals, adjustments, and miscellaneous/unlisted code review • Review cases with Medical Director to validate decisions and identify opportunities to create medical policy where guidelines are absent • Assist with research of health plan coding questions • Identify potential billing errors, abuse, and fraud • Identify potential cases warranting prepayment review • Maintain appropriate records, files, and documentation • Perform other duties as assigned • Comply with all 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 • License/certification: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic • Experience in provider communication and education 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 • Additional forms of incentives may be included in total compensation • Benefits may be subject to program eligibility