Supervisor, Payment Integrity- Coding & Clinical (DRG)

Centene
Missouri
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Quality & Regulatory (Non-Software)Experience: 6+ yearsEducation: bachelorsSkills: ["Leadership","Quality assurance","Attention to detail","Data analysis","Cross-functional collaboration"]

Supervise and coordinate the day-to-day work of a Coding & Clinical Review team within Payment Integrity, ensuring accurate DRG assignment, clinical validation, and audit outcomes. Lead quality assurance activities like audits, calibration sessions, and inter-rater reliability reviews, and support appeals by reviewing documentation and guiding responses. Monitor performance, resolve complex escalations, analyze audit data for trends, and drive compliant execution of coding and clinical standards aligned with ICD-10-CM/PCS and AHIMA ethics.

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FursaFursa
Centene
Centene
1 month ago

Supervisor, Payment Integrity- Coding & Clinical (DRG)

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Last checked: 24 days agoStatus: Live

Job Summary

Supervise and coordinate the day-to-day work of a Coding & Clinical Review team within Payment Integrity, ensuring accurate DRG assignment, clinical validation, and audit outcomes. Lead quality assurance activities like audits, calibration sessions, and inter-rater reliability reviews, and support appeals by reviewing documentation and guiding responses. Monitor performance, resolve complex escalations, analyze audit data for trends, and drive compliant execution of coding and clinical standards aligned with ICD-10-CM/PCS and AHIMA ethics.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Manager level

Key Responsibilities

  • •Supervise and coordinate Coding & Clinical Review staff to complete DRG audit, QA, readmissions, appeals, and related workflows.
  • •Monitor and evaluate team performance against productivity, quality, and service level expectations and address gaps.
  • •Provide guidance on coding, clinical validation, and audit determinations using ICD-10-CM/PCS, DRG methodologies, and payer/regulatory policies.
  • •Review and resolve complex/escalated cases and elevate high-risk issues to management as needed.
  • •Conduct quality assurance activities (audits, calibration sessions, inter-rater reliability) and support appeals by validating determinations and guiding responses.

Pay and Benefits

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

Key Requirements

  • •Associate's Degree in Health Information Management, Nursing, or related field.
  • •6+ years performing MS-DRG and APR-DRG coding.
  • •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).
  • •RHIT, CCS (CCS-Certified Coding Specialist) / CIC, or CCDS required; RN with state/compact licensure and coding credential preferred.
Experience:6+ years
Education:Bachelor's in Health Information Management, Nursing, or related field
Skills:LeadershipQuality assuranceAttention to detailData analysisCross-functional collaboration
Licenses:RN - Registered Nurse state licensureRN - Registered Nurse compact state licensure
Certifications:RHITCCS-Certified Coding SpecialistCICCCDS
Tech Stack:MS-DRGAPR-DRGDRGDRG codingDRG reviewsICD-10-CMICD-10-PCSTruCode/TruBridge3MOptum EncoderWebstratPSIAHIMAInter-rater reliability

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