Centene Corporation Senior Coding Analytics Specialist in Chesterfield, Missouri

HourlyResearch, investigate, and resolve escalated inquiries and issues related to code editing adjudication for all health plans.

Triage all incoming inquiries and cases, answering escalated questions and issues from health plans and claim departments based on expertise of CMS, NCCI, CPT, and state coding guidelines

Provide research necessary to address issues and concerns that potentially prevent provider abrasion and explain to providers why claims have been denied

Train and audit team members on systems, coding principles, and state-specific guidelines using subject matter expertise of departmental protocols and state health plan guidelines

Maintain departmental policies and procedures for state health plans

Allocate and oversee daily workload for state health plans assigned, including code editing reviews, adjustments and appeals within code editing software systems (HCI and CXT)

Assist in identification of coding trends, cost savings, impact of adjustments/appeals to savings, and provider usage

Education/Experience:

Associate’s degree in Medical Billing and Coding, Healthcare, related field, or equivalent experience. 3+ years of medical billing/insurance, CPT coding, claims, coding analysis, or physician/hospital data management experience. Experience using code editing software systems in a managed care organization preferred

License/Certificates: Certified Professional Coder (CPC) preferred.

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.

TITLE: Senior Coding Analytics Specialist

LOCATION: Chesterfield, Missouri

REQNUMBER: 1113545

COMPANY: Compliance

POSITION TYPE: Hourly