Prepay Compliance Analyst (Fraud, Waste, & Abuse)
Company Name:
Centene
## Description
Position Purpose: Apply accept/reject recommendations to claims clinically reviewed by third party vendor by using knowledge of medical claims billing, coding, and other compliance or reimbursement related issues.
Accept/reject clinical coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, precedent or other guidelines to perform analysis of provider billing against Current Procedural Terminology (CPT) coding logic and rules.
Finalize reimbursements based upon audit findings.
Assist with research of health plan coding questions.
Maintain appropriate records, files, documentation, etc.
## Qualifications
Education/Experience: High school diploma or equivalent. 1+ years of general office/administrative, coding, claims processing, physician's office and/or data management experience. Experience in customer service and/or provider relations. Knowledge of Federal and State Medical guidelines is preferred.
License/Certification: Certified Procedural Coding (CPC) preferred.
## Job
Job: Compliance
Primary Location: USA-Missouri-Chesterfield
Organization: Payment Integrity
Schedule: Full-time
Req ID: 1001802
Centene
## Description
Position Purpose: Apply accept/reject recommendations to claims clinically reviewed by third party vendor by using knowledge of medical claims billing, coding, and other compliance or reimbursement related issues.
Accept/reject clinical coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, precedent or other guidelines to perform analysis of provider billing against Current Procedural Terminology (CPT) coding logic and rules.
Finalize reimbursements based upon audit findings.
Assist with research of health plan coding questions.
Maintain appropriate records, files, documentation, etc.
## Qualifications
Education/Experience: High school diploma or equivalent. 1+ years of general office/administrative, coding, claims processing, physician's office and/or data management experience. Experience in customer service and/or provider relations. Knowledge of Federal and State Medical guidelines is preferred.
License/Certification: Certified Procedural Coding (CPC) preferred.
## Job
Job: Compliance
Primary Location: USA-Missouri-Chesterfield
Organization: Payment Integrity
Schedule: Full-time
Req ID: 1001802
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