Supervisor, Payment Integrity- Coding & Clinical (DRG)

Centene Corporation•Remote-MO, MO

3d•$87,700 - $157,800•Remote

About The Position

Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This Remote Role requires a minimum of 6+ years of MS-DRG and APR-DRG coding experience and 3+ years of conducting DRG reviews for a Payment Integrity vendor or payer experience. The purpose of this position is to 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.

Requirements

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
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

Nice To Haves

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.