Medical Coding Reviewer I
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About The Position
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. The position is remote. The position purpose is to perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. Responsibilities include analyzing provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion. You will review medical records to ensure billing is consistent with medical records for appeals, adjustments and miscellaneous/unlisted code review. Additionally, you will review cases with the Medical Director to validate decisions and identify opportunities to create medical policy in the absence of guidelines, assist with research of health plan coding questions, identify potential billing errors, abuse, and fraud, and flag potential cases which may warrant a prepayment review. You will also maintain appropriate records, files, documentation, etc., and perform other duties as assigned while complying with all policies and standards.
