Job Description

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.

Must be willing to travel to NYC twice a year for required meetings.

Position Purpose:
The focus of this position is to establish processes to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review, hospital readmission review and outlier payment review.

• Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance.

• Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues.

• Provide regular reports on project status and progress; report project results to identify coding improvement opportunities.

• Collaborate with other business units to identify and implement process efficiency and quality improvement practices.

• Work with IT resources to implement system efficiencies and configuration enhancements to improve claims processing operations.

• Apply Coding Guidelines as described in the ICD-10 Coding Manual.
• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience:
RN Degree. One year experience preferred in hospital inpatient coding. Nursing experience in managed care organization or acute care hospital.

For Fidelis Care only: One year of experience in a clinical setting or acute care hospital; RN, PA, MD, APRN, DO or MBBS license required. Coding Credential Required: Valid/Current CPC Certification, through APPC preferred or CIC through AAPC or CCS through AHIMA; RHIA/RHIT Credentials-Preferred.

Pay Range: $68,700.00 - $123,700.00 per year

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. Total compensation may also include additional forms of incentives.

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

Job Tags

Full time, Work at office, Remote work, Flexible hours,

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