Coding Analytics Specialist I (Medical)
Posted on: 20 Mar 2021
Tampa, FL
Job Description
Position Purpose:
* Accept or reject coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, precedent or other guidelines under the guidance of senior team members or management
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* Compare provider billing and code auditing recommendations based on regulatory (Current Procedural Terminology) coding logic and state, CMS, and NCCI guidelines and rules
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* Investigate and process appeals and adjustments for claims denied in code editing software systems (HCI or CXT)
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* Maintain appropriate records, files, and documentationValidate correct coding recommendations against state, CMS, and NCCI guidelines, resulting in cost savings to Centene for pre-payment, adjustments, and appeals.
Education/Experience:
High school diploma or equivalent. 1+ years of medical billing/insurance, CPT coding, claims, coding analysis, or physician/hospital data management experience.
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.
Centene
St Louis, MO
Centene Corporation operates as a diversified and multi-national healthcare enterprise that provides programs and services to under-insured and uninsured individuals in the United States. The company’s Managed Care segment offers health plan coverage to individuals through government subsidized programs, including Medicaid, the State children’s health insurance program, long-term services and support, foster care, and medicare-medicaid plans, which covers dually eligible individuals, as well as aged, blind, or disabled programs. Its health plans include primary and specialty physician care, inpatient and outpatient hospital care, emergency and urgent care, prenatal care, laboratory and X-ray, home-based primary care, transportation assistance, vision care, dental care, telehealth, immunization, specialty pharmacy, therapy, social work, nurse advisory, and care coordination services, as well as prescriptions, limited over-the-counter drugs, medical equipment, and behavioral health and abuse services.
This segment also offers various individual, small group, and large group commercial healthcare products to employers and directly to members in the Managed Care segment.Its Specialty Services segment provides pharmacy benefits management services; health, triage, wellness, and disease management services; and vision and dental, and management services, as well as care management software that automate the clinical, administrative, and technical components of care management programs. This segment offers its services and products to state programs, correctional facilities, healthcare organizations, employer groups, and other commercial organizations. The company provides its services through primary and specialty care physicians, hospitals, and ancillary providers. Centene Corporation was founded in 1984 and is headquartered in St. Louis, Missouri.
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IndustryHealthcare
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No. of Employees47, 300
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Website
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Jobs Posted349
