Supervisor, Payment Integrity- Coding & Clinical (DRG)

Centene
Missouri
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Administration & Executive AssistanceExperience: 6+ yearsEducation: associatesSkills: ["Team supervision","Quality assurance","Data analysis","Compliance","Problem resolution"]

Supervise and coordinate the daily work of a Coding & Clinical Review team within Payment Integrity, ensuring accurate MS-DRG/AR-DRG assignment, clinical validation, and audit outcomes. Lead quality assurance activities, calibration sessions, and inter-rater reliability reviews. Resolve complex escalated coding/clinical determinations, support appeals, analyze operational and audit data to drive improvements, and ensure compliance with payer, regulatory, and AHIMA ethical standards.

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FursaFursa
Centene
Centene
1 month ago

Supervisor, Payment Integrity- Coding & Clinical (DRG)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 24 days agoStatus: Live

Job Summary

Supervise and coordinate the daily work of a Coding & Clinical Review team within Payment Integrity, ensuring accurate MS-DRG/AR-DRG assignment, clinical validation, and audit outcomes. Lead quality assurance activities, calibration sessions, and inter-rater reliability reviews. Resolve complex escalated coding/clinical determinations, support appeals, analyze operational and audit data to drive improvements, and ensure compliance with payer, regulatory, and AHIMA ethical standards.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Administration & Executive Assistance
Seniority: Manager level

Key Responsibilities

  • •Supervise and coordinate day-to-day Coding & Clinical Review activities to ensure timely, accurate completion of DRG audits, QA, readmissions, appeals, and/or operational workflows.
  • •Monitor and evaluate team performance against productivity, quality, and service level expectations, addressing gaps as needed.
  • •Provide guidance on coding, clinical validation, and audit determinations using ICD-10-CM/PCS, DRG methodologies, and payer/regulatory policies.
  • •Review and resolve complex or escalated cases and elevate high-risk issues to management; support appeals by validating determinations and guiding responses.
  • •Conduct audits, calibration sessions, and inter-rater reliability reviews; analyze operational/audit data for trends and improvement opportunities while ensuring compliance with AHIMA ethics.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •6+ years performing MS-DRG and APR-DRG coding experience.
  • •3+ years conducting DRG reviews for a Payment Integrity vendor or payer.
  • •3+ years DRG encoder/grouper experience (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar).
  • •Associate's Degree in Health Information Management, Nursing, or related field.
  • •Hold RHIT or CCS-Certified Coding Specialist (CIC) or Certified Clinical Documentation Specialist (CCDS); RN licensure is preferred.
Experience:6+ yearsPayment integrityDRG codingHealthcare auditing
Education:Associate's
Skills:Team supervisionQuality assuranceData analysisComplianceProblem resolution
Licenses:RN
Certifications:RHITCCSCICCCDS
Tech Stack:MS-DRGAPR-DRGICD-10-CM/PCSTruCodeTruBridge3MOptum EncoderWebstratPSI

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