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Supervisor, Coding Analytics

Chesterfield, Missouri Apply Now Job ID 1145948 Category Compliance Organization Centene Corporation Schedule Full-time
Description:

Position Purpose:

Ensure Coding Analytics team consistently meets production standards and passes quality audits (approximately 15 team members)
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

Flexible to work overtime based on business needs

Qualifications:

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.

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.

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