[Hiring] Supervisor, Payment Integrity- Coding & Clinical @Centene Corporation

Role Description

You could be the one who changes everything for our 28 million members. 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.

Position Purpose:

• Supervise and coordinate the day-to-day activities of the Coding & Clinical Review team within Payment Integrity.
• Ensure accurate diagnosis-related group assignment, clinical validation, and audit outcomes in alignment with established policies, regulatory requirements, and organizational objectives.
• Execute strategies and initiatives established by leadership while driving team performance, quality, operational efficiency, and consistent application of coding and clinical review standards.
• Oversee diagnosis-related group audit, Quality Assurance, Readmissions, Appeals, or broader operational teams.
• Serve as a subject matter expert for complex coding, clinical validation, and audit-related matters.
• Adhere to and promote 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

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.

Requirements

• 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.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.