Centene Corporation logo
Centene Corporation

Transforming the health of the communities we serve, one person at a time.

Director, Payment Integrity

DirectorDirectorFull TimeRemoteLeadTeam 10,001+Since 1984H1B No SponsorCompany SiteLinkedIn

Location

Missouri

Posted

2 days ago

Salary

$118.4K - $219K / year

Seniority

Lead

Bachelor Degree7 yrs expEnglish

Job Description

Director, Payment Integrity

Centene Corporation

• Oversee prepay waste and abuse reviews through coding, editing, and audit programs • Provide guidance and set policies to ensure all programs adhere to state and federal regulations as well as company policies • Oversee prepay editing and retrospective audits to ensure accurate and timely payments of coding and pricing issues • Interpret audit results, develop action plans and present findings to senior management • Develop and implement continuous processes from analytic design to final report stage • Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures • Monitor laws and regulations that may impact payment integrity policies and procedures and implement changes while maintaining compliance with all state and federal regulations • Recommend process improvement to assist in developing and executing strategic initiatives and goals • Develop and deliver educational training programs to providers and employees to streamline operational processes and ensure accurate coding • Direct and lead Prepay Compliance Managers in their efforts to reduce waste, abuse, and fraud • Performs other duties as assigned • Complies with all policies and standards

Job Requirements

  • Bachelor’s degree in Accounting, Finance, Nursing, Operations Management, Healthcare related, or related field or equivalent experience
  • 7+ years of finance, accounting, operations, or auditing experience
  • Experience in claims operations preferred
  • Compliance/ERM: 7+ years experience 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

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