Job Description

Be among the first 25 applicants.

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, youll 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 their 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; review 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.
• Perform other duties as assigned.
• Comply 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 are 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 skills, experience, education, and other job-related factors permitted by law. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Additional Details

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Health Care Provider

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