Supervisor, Payment Integrity – Appeals & Disputes

🔥 45 minutes ago

🐊 Florida, Illinois, +2 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead clinical coding compliance nurses and non-clinical team members through the code editing adjudication process • Oversee prepay compliance, adjustments, and appeals for multiple code editing software systems • Ensure the Coding Analytics team meets production standards and passes quality audits • Oversee relationships with health plans, Claims, and other departments • Identify and implement best practices and operational efficiencies • Serve as a health plan account liaison and provide expertise on code editing decisions • Research coding questions and issues • Provide expert testimony in state fair hearings and to health plan leadership regarding state complaints from providers • Triage and resolve escalated health plan, Claims department, and provider inquiries or issues • Coordinate communication across IT, health plans, vendors, and affected departments • Perform other duties as assigned

🎯 Requirements

• Associate’s degree in Medical Billing and Coding, Healthcare, related field, or equivalent experience • 5+ years of account management, nursing, healthcare management, medical billing, CPT coding, claims, coding analysis and trends, and/or data management experience • Experience using code editing software systems in a managed care organization preferred • Current state’s RN license or Certified Professional Coder (CPC) preferred • Compliance with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation