Remote DRG Coding & Clinical Supervisor (Payment Integrity)

Centene Management Company LLC; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K plans

Stock purchase plan

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Senior Manager to supervise the Coding & Clinical Review team within Payment Integrity, guiding DRG assignment, clinical validation, and audit outcomes in line with policies and regulatory requirements. You will lead staff, monitor performance, and ensure adherence to ICD-10-CM/PCS guidelines while supporting appeals and process improvements.

You will drive operational excellence, collaborate with Medical Directors and Compliance, and uphold a culture of integrity, with a

Qualifications

• 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

Responsibilities

• 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.

Skills

Leadership

Team supervision

DRG coding knowledge

Regulatory compliance

Education

Associate's Degree in Health Information Management

Tools

TruCode/TruBridge

3M Encoder

Optum Encoder

Webstrat

PSI

Job description

Centene is seeking a Senior Manager to supervise the Coding & Clinical Review team within Payment Integrity, guiding DRG assignment, clinical validation, and audit outcomes in line with policies and regulatory requirements. You will lead staff, monitor performance, and ensure adherence to ICD-10-CM/PCS guidelines while supporting appeals and process improvements.

You will drive operational excellence, collaborate with Medical Directors and Compliance, and uphold a culture of integrity, with a