Coding Quality Specialist

Centene Corporation

. Performs complex reviews of physician clinical documentation on inpatient and outpatient medical records .

Posted 10/7/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $56,200 - $101,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical documentation review, coding compliance, and reimbursement methodologies, with a strong focus on ICD-9-CM/ICD-10-CM/PCS, CPT, and HCPCS coding. Capable of developing case-specific rationales and conducting peer reviews while ensuring adherence to coding guidelines and standards.

Highest-signal resume keywords

ICD-10-CM CodingCPT CodingHCPCS CodingRegistered Health Information Technician (RHIT)Certified Coding Specialist (CCS)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Diagnosis Related Groups (DRG)Coding ComplianceQuality AnalysisClinical Documentation ReviewCoding Guidelines Application

Soft Skills

CommunicationProblem-SolvingAttention to Detail

Tools & Technologies

Coding ClinicsCoding Newsletters

Certifications & Qualifications

Registered Health Information Administrator (RHIA)Certified Coding Associate (CCA)Certified Professional Coder (CPC)

Industry Keywords

Medical RecordsReimbursement MethodologyPeer ReviewFraud DetectionClinical Education

About the role

Key responsibilities & impact

Performs complex reviews of physician clinical documentation on inpatient and outpatient medical records
Performs quality analysis to validate diagnostic and procedural coding and the application of official coding guidelines and rules
Determines correct payment methodology and reimbursement
Develops case-specific written rationale to substantiate and communicate findings to hospitals, providers, medical directors, and peer review teams
Conducts coding re-review for decisions based on coding convention and sequencing guidelines
Identifies clinical questions and refers cases to Medical Director
Responds to providers for resolution of appeals
Reviews updates to Coding Clinics, coding newsletters, and other professional resources
Participates in ongoing in-service programs for coding-related or clinical education
Identifies and interprets patterns of possible fraud or abuse and refers them for further evaluation and corrective action
Conducts periodic peer reviews
Complies with all policies and standards
Performs other duties as assigned

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
AA in Health Information Technology preferred
Two years experience with Diagnosis Related Groups (DRG), ICD-9-CM/ICD-10-CM/PCS, CPT, and HCPCS coding
One or more of the following certifications may be required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC)
Up-to-date knowledge of Coding Clinics, coding newsletters, and other professional resources

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity