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Medical Coding Reviewer I

Company: Centene Corporation
Location: Chesterfield
Posted on: November 30, 2018

Job Description:

Description Position Purpose: Perform clinical/coding medical claimreview to ensure compliance with coding practices through a comprehensivereview and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporatepolicies and procedures and guidelines established by the American MedicalAssociation and the Centers for Medicare and Medicaid Services. --Analyze provider billing practices by utilizingcode auditing software, provider documentation, administrative policies,regulatory codes, legislative directives, precedent, AMA and CMS code editcriterion. --Review medical records to ensure billing isconsistent with medical record for appeals, adjustments andmiscellaneous/unlisted code review. --Review cases with Medical Director to validatedecisions and identify opportunities to create medical policy in the absence ofguidelines --Assist with research of health plan codingquestions. --Identify potential billing errors, abuse, andfraud. --Identify opportunities to flag potential caseswhich may warrant a prepayment review (versus an automatic system denial orpayment). --Maintain appropriate records, files,documentation, etc Qualifications Education/Experience: Associate's degree in related field or equivalent experience. Coding certification and 2+ years of experience in medical billing & coding OR RN/LPN and 2+ years of related clinical experience. Experience in provider communication and education preferred.-- License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, or CPMA Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Centene Corporation, Chesterfield , Medical Coding Reviewer I, Healthcare , Chesterfield, Missouri

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