Clinical Policy Coding Analyst

Centene
Indiana
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Government Affairs & Public PolicyExperience: 4+ yearsEducation: associatesSkills: ["Research skills","Attention to detail","Cross-functional communication","Analytical thinking"]

Provide clinical policy coding support to ensure accuracy of Clinical Coverage Guidelines (CCGs) and Claims Edit Guidelines (CEGs), and maintain authorization management tools. Lead evidence-based updates to support medical necessity reviews, research Medicare/Medicaid regulations, and implement coding rule changes. Oversee hand-off of CCGs/CEGs to the Coding Integrity team, coordinate with systems and vendors, support committees, and defend coding decisions in internal/external audits.

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FursaFursa
Centene
Centene
6 days ago

Clinical Policy Coding Analyst

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Source: Company careers pageValidated by: Fursa AI
Last checked: 7 hours agoStatus: Live

Job Summary

Provide clinical policy coding support to ensure accuracy of Clinical Coverage Guidelines (CCGs) and Claims Edit Guidelines (CEGs), and maintain authorization management tools. Lead evidence-based updates to support medical necessity reviews, research Medicare/Medicaid regulations, and implement coding rule changes. Oversee hand-off of CCGs/CEGs to the Coding Integrity team, coordinate with systems and vendors, support committees, and defend coding decisions in internal/external audits.
Location: Indiana
Workplace: Remote
Employment Type: Full time
Job Function: Government Affairs & Public Policy
Seniority: Mid level

Key Responsibilities

  • •Direct initial review and ongoing updates to CCGs using evidence-based clinical policy and coding rules to support medical necessity reviews.
  • •Lead revisions to CEGs and development of new CEGs, including in-depth research of state and federal regulations and coding guidelines.
  • •Oversee hand-off of CCGs and CEGs to the Coding Integrity team and ensure required system edits are implemented.
  • •Evaluate clinical/financial/claims coding rule change requests, including research supporting Medical Expense Initiatives (MEIs) and contractual or implementation-driven changes.
  • •Serve as a subject matter expert across medical management, supporting platform delivery, committee work, vendor liaison, and responses to complex coding/payment policy inquiries.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Perks:Health Insurance401kEquityPaid LeaveHolidays

Key Requirements

  • •Associate's Degree in a related field or equivalent experience.
  • •4+ years of experience in medical coding with a facility, provider, or payer organization.
  • •Knowledge of Medicare and Medicaid.
  • •A license/certification in at least one of: RHIA, RHIT, CCS, CCS-P, or CPC/CPC-H.
  • •Ability to meet productivity and accuracy standards and defend coding decisions to internal and external audits.
Experience:4+ yearsHealthcareMedical coding
Education:Associate's
Skills:Research skillsAttention to detailCross-functional communicationAnalytical thinking
Certifications:RHIARHITCCSCCS-PCPCCPC-H

Eligibility

Visa:H-1BL-1O-1H-1B1F-1J-1OPTCPT
Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn