About the Role
At Centene, we’re transforming healthcare for 28 million members nationwide. We’re looking for an experienced medical coder with Fraud, Waste, and Abuse (FWA) expertise to help ensure compliance, accuracy, and integrity in our claims review process. In this role, you’ll conduct detailed reviews of medical claims and records, provide expert guidance, and contribute to reducing FWA across our health plans.
Key Responsibilities
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Review medical claims, records, and claim histories for compliance with coding guidelines, state regulations, and Centene policies.
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Provide coding and clinical decisions on first-time claims, adjustments, and appeals.
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Serve as an expert witness in state fair hearings and provider calls to defend payment decisions.
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Develop and maintain review guidelines for medical coding audits.
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Support provider education and participate in medical record auditing.
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Collaborate with internal teams to align reviews with business needs and regulatory requirements.
Qualifications
Education & Experience:
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Associate’s Degree in Nursing or related field required.
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4+ years of medical coding experience (including provider education, auditing, and managed care).
Licensure/Certifications (one or more required):
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Nursing: LPN or RN (State/Compact License).
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Coding: CPC, CPC-H, CPC-P, CPC-A, CCS, CCS-P, RHIT, RHIA.
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Other Credentials: CPMA, MRT, or Paramedic license.
Why Join Centene?
We offer a comprehensive benefits package designed to support your professional and personal well-being, including:
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Competitive pay with incentive opportunities.
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Medical, dental, and vision insurance.
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401(k) with company match & stock purchase plans.
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Tuition reimbursement & professional development.
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Paid time off plus holidays.
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Flexible work options: remote, hybrid, or in-office.
About Centene
As one of the nation’s largest not-for-profit healthcare organizations, Centene is dedicated to improving the health of our communities one person at a time. We embrace diversity, equity, and inclusion, and provide opportunities for all employees to grow and thrive.
Centene is an Equal Opportunity Employer. Applicants with criminal histories will be considered in accordance with applicable laws, including the LA County Fair Chance Ordinance and California Fair Chance Act.