Remote Payment Integrity Lead — Coding & Compliance

Centene Management Company LLC; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Comprehensive benefits

Remote/hybrid work options

Job summary

Centene Management Company LLC is hiring to lead clinical coding compliance teams through code editing adjudication, ensuring quality and adherence to audits. You will oversee relationships with health plans and claims, driving KPI performance and operational efficiencies.

The role requires an Associate’s degree in Medical Billing and Coding and 5+ years of healthcare management or coding experience, with CPC/RN preferred.

Qualifications

• Associate’s degree or equivalent experience in Medical Billing and Coding, healthcare, or related field.
• 5+ years of account management, nursing, healthcare management, medical billing or coding, or data management experience.
• Experience using code editing software systems in a managed care organization is preferred.

Responsibilities

• Lead clinical coding compliance teams and oversee the code editing adjudication process.
• Manage relationships with health plans, claims, and other departments to influence KPIs.
• Identify best practices and operational efficiencies across coding processes.
• Provide expert testimony in state hearings and during provider discussions.
• Triage escalated inquiries from health plans, Claims, and providers and resolve issues.

Skills

Coding compliance leadership

Team leadership

Account management

Stakeholder communication

Education

Associate’s degree in Medical Billing and Coding

Tools

Code editing software

Job description

Centene Management Company LLC is hiring to lead clinical coding compliance teams through code editing adjudication, ensuring quality and adherence to audits. You will oversee relationships with health plans and claims, driving KPI performance and operational efficiencies.

The role requires an Associate’s degree in Medical Billing and Coding and 5+ years of healthcare management or coding experience, with CPC/RN preferred.