Coding Quality Specialist

Centene Corporation•Remote-TX, TX

1d•$56,200 - $101,000•Hybrid

About The Position

The Coding Quality Coordinator II is the journey level position within a job series that performs complex reviews of clinical documentation on inpatient and outpatient medical records. Validates accuracy of diagnostic and procedural coding, payment methodology, and reimbursement amount; develops written rationale of findings; responds to providers for resolution of appeals. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
AA, Health Information Technology, preferred.
Two years experience with Diagnosis Related Groups (DRG), ICD-9-CM/ ICD-10-CM/PCS, CPT, 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)

Responsibilities

Performs complex review of physician clinical documentation on inpatient and outpatient medical records.
Performs quality analysis to determine accuracy of diagnostic and procedural coding, the correct interpretation and application of official coding guidelines and rules, and assignment of appropriate codes.
Determines correct payment methodology and reimbursement.
Develops case-specific written rationale to substantiate and communicate findings to hospital, provider, medical director, and peer review team.
Conducts coding re-review for decisions that are based on coding convention and sequencing guidelines, not requiring medical review.
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 to maintain up-to-date knowledge.
Participates in ongoing in-service programs for coding-related or clinical education.
Identifies and interprets patterns of possible fraud or abuse and refers to appropriate party for further evaluation and corrective action.
Conducts periodic peer reviews.
Performs other duties as assigned.
Complies with all policies and standards.