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Transforming the health of the communities we serve, one person at a time.
Senior Director, Payment Integrity – Governance
Location
Missouri
Posted
107 days ago
Salary
$148K - $274.2K / year
Seniority
Senior
Job Description
Senior Director, Payment Integrity – Governance
Centene Corporation
• Oversee a full range of waste, abuse and/or fraud investigations, audits and medical code editing scenarios • Ensure all audits and edits adhere to federal and state Medicaid medical coding and fraud/abuse guidelines • Oversee various functions of the Payment Integrity department for accurate and timely operational reviews and final reviews • Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks • Develop and implement continuous editing and auditing processes from analytic design to final report stage • Identify and direct the implementation of new software packages as necessary • Ensure compliance with all state and federal regulations for waste/fraud/abuse and medical coding • Develop corporate policies and procedures and implement corporate initiatives set upper management • Collaborate with Providers, as needed, to train on the payment integrity rules and regulations • Performs other duties as assigned • Complies with all policies and standards
Job Requirements
- Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent experience
- 10+ years of related compliance and/or special investigation experience in managed care or CMS.
- Compliance/ERM: 10+ years of experience preferred
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work
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