Remote Clinical & Coding Review Manager

Centene Corporation; Michigan; On-site; USD 120,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off + holidays

Flexible work setup

Job summary

Centene Corporation seeks a Manager of Complex Claim Reviews to lead teams performing advanced claim audits and ensure regulatory compliance. You will optimize billing processes, mentor staff, and drive standardized review methodologies across the program.

With expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines, you will steer data-driven insights to improve operations and outcomes while nurturing a high-performance culture.

Qualifications

• 5+ years managerial/supervisory experience
• 8+ years complex medical claim review experience
• 3+ years DRG review experience
• RHIA or RHIT required
• CCS-Certified Coding Specialist required
• CIC and CCDS required
• CDIP preferred
• RN licensure preferred

Responsibilities

• Monitors and optimizes billing and claims processes for accuracy and compliance.
• Leads and mentors high-performing review teams.
• Develops standardized documentation to support objectives and outcomes.
• Provides strategic leadership to review teams, fostering quality and accountability.
• Collaborates with cross-functional stakeholders to drive process improvements.
• Directs daily team operations and maintains transparent communication.
• Oversees end-to-end audit program lifecycle within Payment Integrity.
• Applies ICD-10 coding and CMS/state policy updates to guide decisions.
• Drives documentation initiatives and identifies high-value review opportunities.
• Analyzes audit trends and DRG adjustments to inform program development.
• Expands the program with new complex review types and cross-department collaboration.

Skills

Leadership

Team management

Strategic planning

Process improvement

Regulatory compliance

Analytics

Education

Associate's Degree in health information management, Nursing, or related field

Tools

ICD-10-CM/PCS

MS-DRG

APR-DRG

Readmission

APC

EAPG

Job description

Centene Corporation seeks a Manager of Complex Claim Reviews to lead teams performing advanced claim audits and ensure regulatory compliance. You will optimize billing processes, mentor staff, and drive standardized review methodologies across the program.

With expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines, you will steer data-driven insights to improve operations and outcomes while nurturing a high-performance culture.