Manager, Clinical – Coding Review

Centene Corporation

Centene healthcare manager leading complex clinical and coding reviews. Driving payment integrity, audit compliance, process standardization, and program expansion across remote U.S.

Posted 8/4/2026full-timeRemote • Florida, Missouri, Montana • 🇺🇸 United StatesSeniorLead💰 $107,700 - $199,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in ICD-10 coding, clinical documentation improvement, and complex medical claim reviews while ensuring regulatory compliance and payment integrity. Proven ability to lead teams, analyze performance trends, and implement standardized review methodologies to drive operational excellence.

Highest-signal resume keywords

ICD-10-CM/PCS ProficiencyComplex Medical Claim Review ExperienceDRG Review ExperienceClinical Documentation Improvement ExperienceManagerial/Supervisory Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingClinical Documentation ImprovementDRG ReviewMS-DRG ProficiencyAPR-DRG ProficiencyReadmission ReviewAPC ReviewEAPG ReviewPerformance Trend AnalysisStandardized Review Methodologies

Soft Skills

LeadershipMentoringCommunicationCollaborationStrategic Thinking

Certifications & Qualifications

RHIARHITCCSCICCCDSCDIP

Industry Keywords

Payment IntegrityRegulatory ComplianceAudit Program LifecycleHealth Information ManagementOperational Strategies

About the role

Key responsibilities & impact

Provide strategic leadership for teams performing advanced, complex claim reviews
Ensure review accuracy, regulatory compliance, and achievement of payment integrity goals
Analyze performance trends and standardize review processes and methodologies
Implement consistent clinical and coding review methodologies
Deliver actionable insights to shape operational strategies and informed decision-making
Monitor and optimize business processes and systems for billing and claims payment accuracy, compliance, and integrity
Lead and mentor teams conducting advanced coding and clinical validation reviews
Develop and maintain standardized documentation supporting business objectives and consistent review outcomes
Collaborate with cross-functional stakeholders to identify process improvements and champion innovative solutions
Assign priorities, set goals, and coordinate daily team activities
Maintain transparent communication through regular one-on-one and team meetings
Establish and oversee the end-to-end Payment Integrity audit program lifecycle
Set strategic audit direction, manage and develop teams, and ensure regulatory, contractual, and organizational compliance
Apply expertise in ICD-10 coding, clinical guidelines, and Centene/Health Plan policies to guide review outcomes
Incorporate CMS updates, state regulations, and contractual obligations into operational decisions
Drive documentation initiatives and identify high-value review opportunities within the complex review roadmap
Analyze audit trends and DRG adjustments to inform scalable program development
Identify emerging opportunities within DRG and other review types
Oversee program expansion through new complex review types and cross-departmental collaboration
Integrate robust review protocols for audit operations
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Associate's Degree in health information management, Nursing, or a related field required
5+ years of managerial/supervisory experience required
8+ years of complex medical claim review experience required
3+ years of DRG review experience required
Clinical Documentation Improvement experience required
Proficiency in ICD-10-CM/PCS required
Proficiency in MS-DRG required
Proficiency in APR-DRG required
Proficiency in Readmission, APC, EAPG, and other review types required
One of the following credentials required: RHIA, RHIT, CCS, CIC, or CCDS
CDIP preferred
RN state licensure and/or compact state licensure in combination with a coding credential preferred
Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Accommodation support available for candidates who need it