Clinical Policy Coding Analyst

Centene Corporation

Clinical Policy Coding Analyst supporting Centene’s healthcare policy, coding, and authorization operations. Reviewing coding guidelines, claims edits, regulatory requirements, and medical-management systems.

Posted 8/12/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical coding, including ICD codes and CMS risk adjustment guidelines, while ensuring compliance with regulatory standards and supporting clinical policy development. Proven ability to manage authorization processes and collaborate across departments to enhance operational efficiency.

Highest-signal resume keywords

Medical Coding ExpertiseCMS Risk Adjustment GuidelinesICD Code UnderstandingRegulatory ComplianceRHIA/RHIT/CCS Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingICD CodesClaims Edit GuidelinesAuthorization ManagementClinical Policy DevelopmentRegulatory ResearchCoding Rule EvaluationEvidence-Based CriteriaProduct Development SupportAudit Defense

Soft Skills

CommunicationCollaborationProblem-SolvingAttention to DetailFeedback Collection

Tools & Technologies

Auth Lookup ToolQuick Reference GuidesMedical Management PlatformDigital Communications

Certifications & Qualifications

RHIARHITCCSCCS-PCPCCPC-H

Industry Keywords

MedicareMedicaidClinical Coverage GuidelinesClaims OperationsHealth Outcomes

About the role

Key responsibilities & impact

Support Clinical Policy by ensuring accurate coding of Clinical Coverage Guidelines and Claims Edit Guidelines
Maintain authorization management tools, including the Auth Lookup Tool and Quick Reference Guides
Review and update evidence-based clinical policies, coding rules, regulations, and authorization rules
Lead revisions and development of Claims Edit Guidelines
Research state and federal regulations, coding industry guidelines, and related policies
Support clinical decision-making through evidence-based criteria and authorization rules
Oversee hand-off of guidelines to the Coding Integrity team and ensure system edits are implemented
Support Chief Medical Director projects, vendor coordination, Medical Expense Initiatives, strategic initiatives, Medicaid admits, and authorization rules
Evaluate claims coding rule-change requests from clinical, financial, and claims operations perspectives
Provide regulatory and coding research for Medical Expense Initiatives and contractual or implementation changes
Serve as coding subject matter expert for markets and departments, supporting operations, product development, implementation, health outcomes, and growth initiatives
Support Medicare pre-service turnaround time and appeals projects and standardization of authorization processes
Apply CMS risk adjustment guidelines and assess ICD code impacts on the CMS HCC risk adjustment model
Coordinate activities to meet contractual, regulatory, and internal standards
Deliver clinical policies to the Medical Management Platform and Digital Communications, auditing both access points for accuracy
Prepare Clinical Policy Updates for markets and leadership
Liaise between Medical Management and Systems Integration regarding coding inquiries
Participate in cross-functional projects involving Claims, Product, Operations, markets, and Medicare Planning
Assist with logistics and serve as a coding and claims-payment subject matter expert on the Medical Policy Committee and Claims Payment Policy Committee
Communicate policy changes to markets and collect feedback
Perform other duties as assigned

Requirements

What you’ll need

Associate's Degree in a related field or equivalent experience
4+ years of experience in the medical coding field with a facility, provider, or payer organization
Knowledge of Medicare and Medicaid
A required license or certification: RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H
Ability to meet productivity and accuracy standards
Ability to defend coding decisions during internal and external audits
Complete understanding of CMS risk adjustment guidelines
Understanding of ICD codes and their impact on the CMS HCC risk adjustment model
Ability to meet contractual, regulatory, and internal department standards
Must be authorized to work in the U.S. without current or future employment-based visa sponsorship

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off
Holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation