Manager, Clinical & Coding Review

Centene
Missouri, Michigan, Florida
Workplace: RemoteFull timeUSD 107,700 - 199,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 5+ yearsEducation: associatesSkills: ["Strategic leadership","Mentorship","Process improvement","Accountability","Cross-functional collaboration"]

Provide strategic leadership for teams conducting advanced medical claim reviews to ensure accuracy, regulatory compliance, and payment integrity. Use expertise in ICD-10, CPT/HCPCS, and clinical guidelines to analyze performance trends, standardize review methodologies, and drive scalable audit and review program growth. Lead, mentor, and develop teams; manage an end-to-end audit lifecycle in Payment Integrity; and collaborate cross-functionally to improve processes and expand complex review types.

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Centene
Centene
1 day ago

Manager, Clinical & Coding Review

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Last checked: 5 hours agoStatus: Live

Job Summary

Provide strategic leadership for teams conducting advanced medical claim reviews to ensure accuracy, regulatory compliance, and payment integrity. Use expertise in ICD-10, CPT/HCPCS, and clinical guidelines to analyze performance trends, standardize review methodologies, and drive scalable audit and review program growth. Lead, mentor, and develop teams; manage an end-to-end audit lifecycle in Payment Integrity; and collaborate cross-functionally to improve processes and expand complex review types.
Location: Missouri, Michigan, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Provide strategic leadership to teams performing advanced, complex claim reviews to ensure accuracy, regulatory compliance, and payment integrity.
  • •Monitor and optimize business processes and systems to ensure accuracy, compliance, and billing/claims integrity.
  • •Lead and mentor teams conducting coding and clinical validation reviews, setting priorities, goals, and daily activities.
  • •Establish and oversee the end-to-end audit program lifecycle within Payment Integrity to ensure regulatory, contractual, and organizational compliance.
  • •Analyze audit trends and DRG adjustments, and drive documentation and program expansion for new complex review types.
Travel: Medium travel

Pay and Benefits

Salary: USD 107,700 - 199,300 annually
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Associate's Degree in health information management, Nursing, or a related field required.
  • •5+ years managerial/supervisory experience required.
  • •8+ years complex medical claim review experience required; 3+ years DRG review and Clinical Documentation Improvement experience required.
  • •Proficiency in ICD-10-CM/PCS and MS-DRG/APR-DRG required, including proficiency in Readmission, APC, EAPG, and other review types.
  • •RHIA, RHIT, CCS, Clinical Inpatient Coder (CIC), or Certified Clinical Documentation Specialist (CCDS) required (CDIP preferred; RN licensure/compact with coding credential preferred).
Experience:5+ yearsHealthcareMedical claimsPayment integrity
Education:Associate's
Skills:Strategic leadershipMentorshipProcess improvementAccountabilityCross-functional collaboration
Licenses:RN - Registered Nurse (state licensure/compact state licensure)
Certifications:RHIARHITCCSClinical Inpatient Coder (CIC)CCDSCDIP
Tech Stack:ICD-10-CMICD-10-PCSCPT/HCPCSMS-DRGAPR-DRGCMSDRGAPCEAPGReadmissionICD-10Centene/Health Plan policies

Eligibility

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