Top 608 Claims supervisor Jobs in New York, Ny

RN Readmission Manager, Payment Integrity
Centene Corporation —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
6d
Pre-Authorization Unit Manager
MJHS —New York, NY
- $135,000 - $150,000 a year
- Full-time
- Management
- Mid-level
8d
Clinical Quality Manager
Healthfirst —New York, NY
- $83,100 - $120,360 a year
- Full-time
- Hybrid work
- Mid-level
- Health insurance
- Dental insurance
12d
Manager, Revenue Cycle Management
Daymark Health —New York, NY
- $120,000 - $135,000 a year
- Remote
- System design
- Analysis skills
- Senior level
- Health insurance
Quick Apply
11d
Coding Compliance and Training Supervisor
Weill Cornell Medicine —New York, NY
- $108,600 - $122,500 a year
- Monday to Friday
- HIPAA
- High school diploma or GED
- Supervising experience
11d
Network Contract Manager - Remote NYC
Optum —New York, NY
- $72,800 - $130,000 a year
- Full-time
- Remote
- Customer service
- Pass drug screening
- Data analysis skills
14d
PreAuthorization Unit Manager
MJHS —New York, NY
- $135,000 - $150,000 a year
- Full-time
- Office
- Senior level
- Health insurance
- Dental insurance
8d
Supervisor
1199SEIU Family of Funds —New York, NY
- $66,400 - $83,000 a year
- Full-time
- Writing skills
- Mid-level
- 3 years
Supervisor
Agency ADMIN FOR CHILDREN'S SVCS —Manhattan, NY
- $68,209 - $104,239 a year
- Full-time
- High school
- Mid-level
- Office
- Loan forgiveness
Senior Manager, Health Services
Metropolitan Transportation Authority —New York, NY
- $111,655 - $124,061 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Bachelor of Science
Manager, Benefits Coordination and Claims
EmblemHealth —New York, NY
- $77,760 - $149,040 a year
- Microsoft Outlook
- 5 years
- HIPAA
Billing Manager
White Plains Hospital —White Plains, NY
- $69,996.42 - $105,006.33 a year
- Full-time
- Bachelor of Science
- Mid-level
- Microsoft Office
Strategy & Operations Manager, RCM
Duet —New York, NY
- $110,000 - $140,000 a year
- Full-time
- Hybrid work
- Analysis skills
- Senior level
- Communication skills
Configuration and Quality Audit Manager | Hybrid NY
Healthfirst —New York, NY
- $88,700 - $149,430 a year
- Full-time
- Hybrid work
- 6 years
- Office
- SQL
- Health insurance
- Dental insurance
12d
EHS Manager
Liberty Utilities —Sea Cliff, NY
- $120,925 - $181,387 a year
- 5 years
- Bachelor's degree
- Organizational skills
- Free parking
- Employee stock purchase plan
Manager - Hospital Billing
Huron Managed Services LLC —New York, NY
- $80,000 - $109,000 a year
- Full-time
- 6 years
- Bachelor's degree
- Travel
- Health insurance
- Dental insurance
Quick Apply
1d
Claims Billing Manager, Medical Care At Home (Athena Experience Preferred)
VNS Health —Manhattan, NY
- $66,300 - $72,000 a year
- Full-time
- Microsoft Excel
- Research
- Mid-level
- Continuing education credits
- Paid holidays
Senior RCM Manager
Amperos —New York, NY
- $100,000 - $150,000 a year
- Full-time
- Office
- Analysis skills
- Team management
- Commuter assistance
- Health insurance
Senior Manager / Director, Carrier Operations
Whatnot —New York, NY
- $234,000 - $325,000 a year
- Full-time
- Remote
- 8 years
- SQL
- Analysis skills
- Paid parental leave
- Health insurance
8d
eCommerce Manager Delivery Claims & Incidents
Hermès Paris —Manhattan, NY
- $88,746 - $99,839 a year
- Weekends as needed
- Microsoft Excel
- Mid-level
- Bachelor's degree
- Profit sharing
- Paid parental leave

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RN Readmission Manager, Payment Integrity

Centene Corporation -
New York, NY

Apply Now

Job Details

Full-time
$87,700 - $157,800 a year
6 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Medical claims processing software
Healthcare team management
Healthcare reimbursement methods
Healthcare coding investigations
Documentation reviews
DRG

Full Job 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.

A Licensed RN paired with a Coding Credential is the candidate this team is seeking for this position that will lead and oversee PI initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy. You will lead a team focused on expanded readmission reviews allowing CNC to ensure payment accuracy as well as alignment with internal policies and regulatory requirements. Experience Required for all RN's with Coding Credentials applying:

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.

Position Purpose:
Manages a team of auditors and clinical professionals and is accountable for audit quality, consistency, and overall program performance for potentially preventable readmissions. Oversees payer readmission review programs to ensure accurate, compliant determinations and achievement of payment integrity objectives. This role directs the identification and validation of potentially preventable readmissions while supporting appropriate reimbursement under MS-DRG and APR-DRG methodologies. Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices.

Lead and oversee Payment Integrity initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy, ensuring alignment with established objectives, internal policies, and regulatory requirements.
Collaborate with Health Plans, Medical Economics, Finance, Compliance, Legal, Provider Relations, and Technology teams to support the design, execution, and ongoing monitoring of readmission and DRG-related Payment Integrity strategies.
Monitor program performance against defined metrics, financial targets, and operational benchmarks, using trend analysis to identify risks, variances, and opportunities for improvement.
Provide leadership and operational oversight to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, consistency, timeliness, and adherence to established review standards.
Ensure compliance with federal and state regulations, managed care organization requirements, contractual obligations, and internal policies governing Payment Integrity and audit activities.
Prepare and present reports, analyses, and performance summaries to leadership and key stakeholders, highlighting audit outcomes, trends, and actionable recommendations.
Identify process gaps, operational risks, and control weaknesses, and implement or recommend corrective actions to improve quality, efficiency, and program effectiveness.
Lead, coach, and develop team members by setting clear expectations, promoting accountability, and fostering a culture of collaboration, quality, and continuous improvement.
Serve as a subject matter expert for Payment Integrity practices within assigned scope, providing guidance on readmission review methodology, audit standards, and reimbursement considerations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or a related field required; an additional four (4) years of directly related experience may be considered in lieu of a degree.

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.
Experience working with payer claims systems preferred.
Demonstrated experience supporting government programs, regulatory compliance, or audit activities preferred.
Project management experience preferred.
Experience partnering with external vendors supporting Payment Integrity audit, recovery, or edit programs preferred.
Inpatient hospital documentation improvement experience preferred.

Master’s degree preferred.

License/Certification: Active Health Information Management or coding credentials required, such as RHIT, RHIA, CCS, CIC, or CCDS or Registered Nurse licensure or higher clinical qualification, in combination with a coding credential, required.

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.

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

Apply Now

Refine Your Search

claims supervisor jobs in new york, ny

RN Readmission Manager, Payment Integrity

Pre-Authorization Unit Manager

Clinical Quality Manager

Manager, Revenue Cycle Management

Coding Compliance and Training Supervisor

Network Contract Manager - Remote NYC

PreAuthorization Unit Manager

Supervisor

Supervisor

Senior Manager, Health Services

Manager, Benefits Coordination and Claims

Billing Manager

Strategy & Operations Manager, RCM

Configuration and Quality Audit Manager | Hybrid NY

EHS Manager

Manager - Hospital Billing

Claims Billing Manager, Medical Care At Home (Athena Experience Preferred)

Senior RCM Manager

Senior Manager / Director, Carrier Operations

eCommerce Manager Delivery Claims & Incidents

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