Supervisor, Payment Integrity - Appeals & Disputes

Position Purpose:
Lead clinical coding compliance nurses and non-clinical team members through the code editing adjudication process that includes prepay compliance, adjustments, and appeals for multiple code editing software systems.

• Ensure Coding Analytics team consistently meets production standards and passes quality audits.
  
• Oversee relationships with health plans, claims, and other departments resulting in a significant impact on Centene’s ability to meet key performance indicators.
  
• Identify and implement best practices and operational efficiencies.
  
• Serve as a health plan account liaison by lending expertise to code editing decisions.
  
• Research coding questions and issues.
  
• Provide expert testimony in state fair hearings and to leadership of health plans when discussing state complaints from providers.
  
• Triage and resolve escalated health plan, Claims department, and provider inquires and/or issues.
  
• Responsible for communication across IT, health plans, vendors, and all other affected departments.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Associate’s degree in Medical Billing and Coding, Healthcare, related field, or equivalent experience. 5+ years of account management, nursing, healthcare management, medical billing, or CPT coding, claims, coding analysis and trends, and/or data management experience.
Experience using code editing software systems in a managed care organization preferred.

Licenses/Certifications: Current state’s RN license or Certified Professional Coder (CPC) preferred.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act