Clinical Investigator I (Special Investigation Unit)

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. ***POSITION IS REMOTE***: ***IDEAL CANDIDATE WILL HAVE RN OR LPN LICENSURE AND CODING EXPERIENCE***: Position Purpose: Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Education/Experience: Associate's Degree related field or equivalent experience preferred 2+ years related clinical experience in the field of obtained license required - Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices - Investigate, analyze, and identify provider billing patterns to recommend payment based on medical records, claim history, billing codes, regulatory and state guidelines, and policies - Prepare summary of findings and recommend next steps for providers - Identify prev...