Director, Payment Integrity - Edit Programs

Centene Corporation•Remote-MO, MO

1d•$118,400 - $219,000•Remote

About The Position

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. This position oversees prepay waste and abuse reviews through coding, editing, and audit programs. It provides guidance and sets policies to ensure all programs adhere to state and federal regulations as well as company policies.

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.
7+ years experience preferred in Compliance/ERM

Responsibilities

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