Cenpatico

  • Tampa, FL


  • Permanent

  • Full-time

Medical Coding Reviewer I (RN/LPN)

USA-Florida-Tampa

Position Purpose:

  • Perform clinical/coding medical claim review to ensure compliance

with coding practices through a comprehensive review and analysis

of medical claims, medical records, claims history, state

regulations, contractual obligations, corporate policies and

procedures and guidelines established by the American Medical

Association and the Centers for Medicare and Medicaid Services.

  • Analyze provider billing practices by utilizing code auditing

software, provider documentation, administrative policies,

regulatory codes, legislative directives, precedent, AMA and CMS

code edit criterion.

  • Review medical records to ensure billing is consistent with

medical record for appeals, adjustments and miscellaneous/unlisted

code review.

  • Review cases with Medical Director to validate decisions and

identify opportunities to create medical policy in the absence of

guidelines

  • Assist with research of health plan coding questions.
  • Identify potential billing errors, abuse, and fraud.
  • Identify opportunities to flag potential cases which may warrant a

prepayment review (versus an automatic system denial or payment).

  • Maintain appropriate records, files, documentation, etc

Education/Experience: 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. Experience in provider communication and

education preferred.

License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P,

RHIT, RHIA, or CPMA

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.

Clinical & Nursing

Full-time

Resume Library

  • View & Apply