Medical Coding Reviewer I

Centene Corporation

. Perform clinical/coding medical claim reviews to ensure compliance with coding practices .

Posted 10/22/2026full-timeRemote • Missouri • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical billing and coding, ensuring compliance with AMA and CMS guidelines while effectively analyzing medical claims and records. Proficient in identifying billing errors and fraud, with strong capabilities in provider communication and education.

Highest-signal resume keywords

Medical Billing & Coding ExperienceCoding CertificationKnowledge of AMA GuidelinesExperience Using Code Auditing SoftwareAbility to Review Medical Records

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claim ReviewCoding PracticesData AnalysisBilling ReviewRegulatory Compliance

Soft Skills

Provider CommunicationAnalytical Thinking

Tools & Technologies

Code Auditing Software

Certifications & Qualifications

CPCCPC-HCPC-PCPC-ACCSCCS-PRHITRHIACPMA

Industry Keywords

Medical RecordsClaims HistoryBilling ErrorsFraud DetectionHealth Plan Coding

About the role

Key responsibilities & impact

Perform clinical/coding medical claim reviews to ensure compliance with coding practices
Analyze medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies, and AMA/CMS guidelines
Analyze provider billing practices using code auditing software and coding criteria
Review medical records for appeals, adjustments, and miscellaneous/unlisted code reviews
Review cases with the Medical Director to validate decisions and identify opportunities for medical policy
Assist with research of health plan coding questions
Identify potential billing errors, abuse, and fraud
Flag potential cases that may warrant prepayment review
Maintain appropriate records, files, and documentation
Perform other assigned duties and comply with policies and standards

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
Associate’s degree in related field or equivalent experience
Coding certification and 2+ years of experience in medical billing & coding, coding/data analysis, accounting/business or physician/hospital data management; or RN/LPN and 2+ years of related clinical experience
One of: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA, CPMA, or Paramedic
Experience in provider communication and education preferred
Knowledge of medical coding practices, AMA and CMS guidelines, regulatory codes, and billing review
Experience using code auditing software
Ability to review medical records, claims history, and provider billing practices

Benefits

Comp & perks

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