Coding Research Analyst - Various, United States - Corporate

Description

You could be the one who changes everything for our 26 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.

Essential Functions: * Manages the external Provider Dispute Process by researching and evaluating escalated disputes and supporting the Medical Director review process.
* Manages research of claims coding rule initiatives including the development of detail work plans.
* Receives and logs requests of changes and appeals to committees ruling.
* Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Market and by Line of Business).
* Documents supporting authority for each claim coding rules by Market and by Line of Business (Master Grid).
* Participate in cross-functional teams to address key claims coding rule issues facing the organization.
* Administers communication to Markets and collects feedback.
* Evaluates change proposal from a regulatory perspective, financial perspective, and claims operational perspectives.
* Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes.
* Identifies coding error (e.g., up coding, bundling/unbundling) and recommends correct coding of medical claims.
* Researches CMS/State laws and AMA guidance.
* Presents change proposal to committee.
* Communicates effectively to markets.
* Develops relationship with claims coding rule software vendors.
* Receives, researches, and determines appropriate action steps for escalated provider disputes from Correspondence, PRT, Claims, and the Markets.
* Trains and/or provides guidance to Claims Coding staff.
* Support claims, configuration, PRT, and/or appeal & grievances teams as necessary.
* Perform other duties as assigned.

Position Purpose: Manages claims coding rule process. Evaluates claims coding rule change request from clinical, financial, and claims operations perspectives. Provides regulatory and correct coding research on change requests and makes recommendations on correct payment policy and edit functionality. Defines requirements and partners with Business Analysts throughout testing and implementation. Manages the external Provider Dispute Process, supporting the front line Provider Resolution Team, evaluating escalated disputes and supporting the Medical Director review process. Candidate Education: Preferred An Associate's Degree in a related fieldCandidate Experience: Required 4+ years of experience in medical coding field with a facility, provider or payer organization Licenses and Certifications:A license in one of the following is required: Required Other Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC)

The salary range for NY is: $ $45.77 per hour

This information reflects the anticipated base hourly range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.