Remote Clinical Coding Review Manager (DRG/ICD-10)

Centene Corporation; Missouri; On-site; USD 108,000 - 199,000; Full time

Job summary

Centene Corporation is seeking a senior leader to manage advanced, complex medical claim reviews. You will provide strategic direction, ensure regulatory compliance, and drive payment integrity goals while mentoring a high-performance team.

You will leverage ICD-10, CPT/HCPCS coding, and clinical guidelines to shape operational strategies and standardize review methodologies across a remote team with travel up to 25%.

Qualifications

• 5+ years managerial/supervisory experience.
• 8+ years complex medical claim review experience.
• 3+ years DRG review experience, Clinical Documentation Improvement experience.
• Proficiency ICD-10-CM/PCS, MS-DRG, APR-DRG.
• Proficiency Readmission, APC, EAPG and other review types.

Responsibilities

• Monitors and optimizes billing and claims processing for accuracy and compliance.
• Leads and mentors high-performing review teams.
• Develops and maintains standardized documentation for review methodologies.
• Provides strategic leadership to review teams and cross-functional partners.
• Collaborates with stakeholders to identify process improvements and innovations.
• Directs team operations with clear priorities and regular meetings.
• Oversees end-to-end audit program lifecycle within Payment Integrity.
• Applies updates to coding policies and guidelines to guide decisions.
• Analyzes audit trends and DRG adjustments for program development.
• Drives expansion of complex review types and cross-department collaboration.

Skills

Leadership

Team management

Collaboration

Education

Associate's Degree in health information management

Tools

ICD-10-CM/PCS

MS-DRG

APR-DRG

Job description

Centene Corporation is seeking a senior leader to manage advanced, complex medical claim reviews. You will provide strategic direction, ensure regulatory compliance, and drive payment integrity goals while mentoring a high-performance team.

You will leverage ICD-10, CPT/HCPCS coding, and clinical guidelines to shape operational strategies and standardize review methodologies across a remote team with travel up to 25%.