Centene

1 month ago

Manager, Payment Integrity- Readmission

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 5 hours agoStatus: Live

Job Summary

Lead and oversee Payment Integrity readmission initiatives in healthcare, directing a team of auditors and clinical professionals to ensure accurate, compliant readmission determinations and DRG validation. Collaborate with Health Plans, Finance, Compliance, Legal, and Technology to design and monitor strategies, drive performance against targets, and improve payment integrity through standardized processes and best practices.

Location: Texas, Florida, Missouri

Workplace: Remote

Employment Type: Full time

Job Function: Administration & Executive Assistance

Seniority: Manager level

Key Responsibilities

•Lead and oversee Payment Integrity initiatives focused on readmissions, cost recovery, and payment accuracy, ensuring alignment with policies and regulatory requirements.
•Provide leadership to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, timeliness, and consistency.
•Collaborate with Health Plans, Finance, Compliance, Legal, Provider Relations, and Technology to design and monitor readmission and DRG strategies.
•Monitor program performance against metrics and targets, using trend analysis to identify risks and opportunities for improvement.
•Develop standardized review criteria, coach staff, and drive continuous improvement in audit quality and program effectiveness.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually

Perks:Health Insurance401kEquityRemote Work

Key Requirements

•5+ years of progressive experience in Payment Integrity, including readmission review and DRG validation activities.
•3+ years of people leadership experience, including direct management of teams.
•2+ years of experience using Diagnosis Related Group encoder and grouper tools (e.g., 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT).
•Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or related field; Master’s preferred.
•Active Health Information Management or coding credentials (RHIT, RHIA, CCS, CIC, CCDS) or RN licensure in combination with a coding credential.

Experience:5+ yearsHealthcarePayerReadmissionDRGCodingManagement

Education:Bachelor's

Skills:LeadershipTeam managementCollaborationAnalytical thinkingProblem-solving

Certifications:RHITRHIACCSCICCCDSRN

Languages:English

Tech Stack:3MOptum EncoderTruCodeTruBridgeWebSTRAT

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

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Centene

1 month ago

Manager, Payment Integrity- Readmission

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 5 hours agoStatus: Live

Job Summary

Location: Texas, Florida, Missouri

Workplace: Remote

Employment Type: Full time

Job Function: Administration & Executive Assistance

Seniority: Manager level

Key Responsibilities

•Lead and oversee Payment Integrity initiatives focused on readmissions, cost recovery, and payment accuracy, ensuring alignment with policies and regulatory requirements.
•Provide leadership to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, timeliness, and consistency.
•Collaborate with Health Plans, Finance, Compliance, Legal, Provider Relations, and Technology to design and monitor readmission and DRG strategies.
•Monitor program performance against metrics and targets, using trend analysis to identify risks and opportunities for improvement.
•Develop standardized review criteria, coach staff, and drive continuous improvement in audit quality and program effectiveness.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually

Perks:Health Insurance401kEquityRemote Work

Key Requirements

•5+ years of progressive experience in Payment Integrity, including readmission review and DRG validation activities.
•3+ years of people leadership experience, including direct management of teams.
•2+ years of experience using Diagnosis Related Group encoder and grouper tools (e.g., 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT).
•Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or related field; Master’s preferred.
•Active Health Information Management or coding credentials (RHIT, RHIA, CCS, CIC, CCDS) or RN licensure in combination with a coding credential.

Experience:5+ yearsHealthcarePayerReadmissionDRGCodingManagement

Education:Bachelor's

Skills:LeadershipTeam managementCollaborationAnalytical thinkingProblem-solving

Certifications:RHITRHIACCSCICCCDSRN

Languages:English

Tech Stack:3MOptum EncoderTruCodeTruBridgeWebSTRAT

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