Medical Coding Reviewer I
Company: Centene Corporation
Posted on: December 5, 2019
Position Purpose: 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
Analyze provider billing practices by utilizing code auditing
software, provider documentation, administrative policies,
regulatory codes, legislative directives, precedent, AMA and CMS
code edit criterion.
Review medical records to ensure billing is consistent with medical
record for appeals, adjustments and miscellaneous/unlisted code
Review cases with Medical Director to validate decisions and
identify opportunities to create medical policy in the absence of
Assist with research of health plan coding questions.
Identify potential billing errors, abuse, and fraud.
Identify opportunities to flag potential cases which may warrant a
prepayment review (versus an automatic system denial or
Maintain appropriate records, files, documentation, etc
Education/Experience: 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. 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, Other , Chesterfield, Missouri
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