Centene Corp

Supervisor, Payment Integrity- Coding & Clinical (DRG)

Centene Corp • $87K — $157K *
US-AnywhereRemote in Missouri, US
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 6+ years of MS-DRG and APR-DRG coding experience
  • 3+ years conducting DRG reviews for a Payment Integrity vendor or payer
  • Proficiency with DRG encoder/grouper applications (e.g., TruCode, 3M)
  • Associate's Degree in Health Information Management, Nursing, or related fields required
  • Relevant coding certification (RHIT, CCS, CIC, or CCDS) required

Responsibilities

  • Supervise and coordinate work of Coding & Clinical Review team
  • Monitor team performance against quality and productivity benchmarks
  • Guide coding and clinical validation according to guidelines
  • Resolve complex cases and escalate high-risk issues
  • Implement departmental policies and program initiatives
  • Conduct quality assurance activities and audits
  • Analyze operational data for improvement opportunities

Benefits

  • Competitive pay and health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement and paid time off
  • Flexible work options (remote, hybrid, or office)
Full Job Description

Remote Role: Minimum experience required 6+ years Performing MS-DRG and APR-DRG coding experience and 3+ years Conducting DRG reviews for a Payment Integrity vendor or payer experience.

Position Purpose:
Supervise and coordinate the day-to-day activities of the Coding & Clinical Review team within Payment Integrity, ensuring accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives. This role executes strategies and initiatives established by leadership while driving team performance, quality, operational efficiency, and consistent application of coding and clinical review standards. The position may oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams and serves as a subject matter expert for complex coding, clinical validation, and audit-related matters. This role also adheres to and promotes American Health Information Management Association Code of Ethics and professional standards.

  • 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.


Education/Experience:

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

Licenses/Certifications:

RHIT - Registered Health Information Technician required or:
CCS-Certified Coding Specialist required or: (CIC) required or

Certified Clinical Documentation Specialist (CCDS) required or: RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse (in combination with a coding credential) preferred

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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