Supervisor, Payment Integrity – Coding & Clinical

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🔥 1 minute ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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

• Supervise and coordinate daily work activities of Coding & Clinical Review staff to ensure timely and accurate completion of DRG audit, QA, readmissions, appeals, and/or operational workflows • Monitor and evaluate team performance against established productivity, quality, and service level expectations; take appropriate action to address gaps • Provide guidance and direction on coding, clinical validation, and audit determinations in accordance with ICD-10-CM/PCS guidelines, DRG methodologies, and applicable payer and regulatory policies • Review and resolve complex or escalated cases; elevate high-risk issues to management as appropriate • Implement and support departmental policies, procedures, and program initiatives to ensure consistent execution of Payment Integrity strategies • Conduct quality assurance activities including audits, calibration sessions, and inter-rater reliability reviews to ensure consistency and accuracy of determinations • Support appeals processes by reviewing clinical documentation, validating determinations, and guiding response development • Analyze operational and audit data to identify trends, variances, and improvement opportunities; communicate findings to management • Ensure compliance with regulatory requirements, internal policies, payer guidelines, and AHIMA ethical standards; reinforce a culture of integrity and accountability • Collaborate with cross-functional partners (e.g., Medical Directors, Provider Relations, Compliance, Appeals) to address issues and improve outcomes • Assist with staff selection, onboarding, training, and workforce planning • Participate in and support process improvement efforts to enhance efficiency, quality, and financial performance • Performs other duties as assigned. Complies with all policies and standards.

🎯 Requirements

• Associate's Degree in Health Information Management, Nursing, or related field required • 6+ years Performing MS-DRG and APR-DRG coding experience required • 3+ years Conducting DRG reviews for a Payment Integrity vendor or payer experience required • 3+ years DRG encoder/grouper experience (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar) experience required • 1+ years Inpatient hospital documentation improvement, complex appeal/dispute review, or auditor education/training experience preferred • RHIT - Registered Health Information Technician required or: CCS-Certified Coding Specialist required or: (CIC) required or Certified Clinical Documentation Specialist (CCDS) required or: RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse (in combination with a coding credential) preferred

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules