Centene Corporation Supervisor, Coding Analytics (Medical) in Chesterfield, Missouri

Pipeline - General

Position Purpose: Lead clinical coding compliance nurses and non-clinical team members through the code editing adjudication process that includes prepay compliance, adjustments, and appeals for multiple code editing software systems.

  • Ensure Coding Analytics team consistently meets production standards and passes quality audits

  • Oversee relationships with health plans, claims, and other departments resulting in a significant impact on Centene’s ability to meet key performance indicators

  • Identify and implement best practices and operational efficiencies

  • Serve as a health plan account liaison by lending expertise to code editing decisions

  • Research coding questions and issues. Provide expert testimony in state fair hearings and to leadership of health plans when discussing state complaints from providers

  • Triage and resolve escalated health plan, Claims department, and provider inquires and/or issues.

  • Responsible for communication across IT, health plans, vendors, and all other affected departments

Education/Experience: Associate’s degree in Medical Billing and Coding, Healthcare,related field, or equivalent experience. 5+ years of account management, nursing, healthcare management, medical billing, or CPT coding, claims, coding analysis and trends, and/or data management experience. Experience using code editing software systems in a managed care organization preferred.

Licenses/Certifications: Current state’s RN license or Certified Professional Coder (CPC) preferred.

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.

TITLE: Supervisor, Coding Analytics (Medical)

LOCATION: Chesterfield, Missouri

REQNUMBER: 009A5

COMPANY: Clinical & Nursing, Leadership

POSITION TYPE: General