Remote DRG Auditor & Compliance Expert

Centene Management Company LLC; United States; Remote; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off & holidays

Job summary

Centene Management Company LLC seeks an experienced Coding Auditor to conduct independent MS-DRG/APR-DRG coding reviews and validate ICD-10-CM/PCS assignments. You will collaborate with the Medical Director on complex cases, influence outcomes, and develop audit concepts when needed.

The role requires 4+ years in MS-DRG/APR-DRG coding, inpatient review experience, and relevant coding certifications. This is a remote position with flexible work arrangements.

Qualifications

• Minimum 4+ years MS-DRG/APR-DRG coding and reviews.
• Experience with inpatient documentation improvement is a plus.
• Authoritative interpretation of coding guidelines and policies.

Responsibilities

• Independently conducts MS-DRG/APR-DRG coding reviews and validates ICD-10-CM/PCS assignments.
• Collaborates with Medical Director on complex cases and outcomes.
• Leads evaluation of complex cases and policy development opportunities.
• Prepare clear audit findings referencing ICD-10 guidelines and Centene policies.
• Assesses claims and records for regulatory and contract compliance.
• Maintain quality and productivity while managing competing priorities.

Skills

MS-DRG/APR-DRG coding

Advanced ICD-10-CM/PCS

Regulatory compliance

Audit reporting

Education

Associate's Degree in HIM

Nursing background

RHIT

RHIA

CCS

RN licensure

Tools

TruCode/TruBridge

3M Encoder

Optum Encoder

WebSTRAT/PSI

Job description

Centene Management Company LLC seeks an experienced Coding Auditor to conduct independent MS-DRG/APR-DRG coding reviews and validate ICD-10-CM/PCS assignments. You will collaborate with the Medical Director on complex cases, influence outcomes, and develop audit concepts when needed.

The role requires 4+ years in MS-DRG/APR-DRG coding, inpatient review experience, and relevant coding certifications. This is a remote position with flexible work arrangements.