Coding Specialist

• 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

Explore Coding Quality Specialist at Centene Corporation. Review requirements and application details.