Manager, Payment Integrity (Remote)

You could be the one who changes everything for our 26 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.

Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes

• Monitor business processes and systems to assure integrity and compliance in billing and claims payment• Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals• Develop customized fraud plans to meet contract and federal requirements• Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis• Respond to RFP request and implement new policies per contractual obligation• Attend state/federal meetings as required by specific contracts• Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes• Review post-payment cases with appropriate parties to obtain refund• Prepare and distribute monthly and quarterly saving reports

Education/Experience:

• Bachelor's degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
• 4+ years of medical claim investigation, compliance or fraud and abuse experience.
• Thorough knowledge of medical terminology required.
• Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred.
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.

License/Certification: Nursing License and Coding Certificate preferred

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.