You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Responsible for leading clinical coding compliance nurses and non-clinical team members through medical claim review. 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.
- Ensures Payment Integrity DRG Review consistently meets production standards and passes quality audits
- Oversees relationships with health plans, claims, and other departments resulting in a significant impact on Centene’s ability to meet key performance indicators
- Identifies and implements best practices and operational efficiencies
- Researches clinical and coding questions and issues
- Triages and resolves escalated health plan, Claims department, and provider inquires/appeals or issues
- Cross communication with IT, health plans, vendors, and all other affected departments
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Associate's Degree in Medical Billing and Coding, Healthcare or related field, or equivalent experience required. 5+ years of account management, nursing, healthcare management, medical billing, or CPT coding, claims, coding analysis and trends, and/or data management experience required. 1+ years experience of using code editing software systems in a managed care organization preferred.
Certifications:
RN - Registered Nurse or LPN - Licensed Practical Nurse - State Licensure and/or Compact State Licensure preferred
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) preferred
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Top Skills
What We Do
Centene provides healthcare solutions to individuals across the United States with more than 23 million members nationwide.
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