Centene

1 day ago

Supervisor, Payment Integrity- Coding & Clinical (DRG)

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 12 hours 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

Website LinkedIn

Loading job details...

Preparing the role view and application actions.

Centene

1 day ago

Supervisor, Payment Integrity- Coding & Clinical (DRG)

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 12 hours agoStatus: Live

Job Summary

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

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

Website LinkedIn