Clinical Investigator I (Special Investigation Unit)

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 NATIONWIDE*****

*****LOOKING FOR CANDIDATE WITH CPC OR CPMA CERTIFICATION*****

**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.

+ 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...