Remote Payment Integrity DRG Lead

Centene Corporation; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/work schedules

Job summary

Centene Corporation seeks a senior leader to supervise the Coding & Clinical Review team within Payment Integrity, ensuring accurate DRG assignments and audit outcomes. This remote role drives quality, efficiency, and adherence to AHIMA standards while coordinating cross-functional partners.

The ideal candidate has 6+ years MS-DRG/APR-DRG coding and 3+ years DRG review experience, with a strong focus on policy, ethics, and operational excellence.

Qualifications

• Associate degree or higher in health information management or related field.
• 6+ years MS-DRG and APR-DRG coding experience.
• 3+ years DRG reviews for a payer, vendor, or health plan.

Responsibilities

• Supervise daily activities of Coding & Clinical Review staff to ensure timely, accurate DRG audit, QA, and appeals.
• Guide coding determinations per ICD-10-CM/PCS guidelines and DRG methodologies.
• Analyze audit data to identify trends and improvements; ensure regulatory compliance and ethics.

Skills

DRG coding

Leadership

Regulatory compliance

Data analysis

Cross-functional collaboration

Education

Associate's Degree in Health Information Management, Nursing, or related field

Tools

DRG encoder/grouper systems (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI)

Job description

Centene Corporation seeks a senior leader to supervise the Coding & Clinical Review team within Payment Integrity, ensuring accurate DRG assignments and audit outcomes. This remote role drives quality, efficiency, and adherence to AHIMA standards while coordinating cross-functional partners.

The ideal candidate has 6+ years MS-DRG/APR-DRG coding and 3+ years DRG review experience, with a strong focus on policy, ethics, and operational excellence.