Manager, Provider Reimbursement Audit
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 leads a team responsible for end-to-end Medicare, Duals, and Marketplace audit activities, including audit planning, execution, reporting, and corrective action monitoring. The role involves managing monthly executive reporting, communicating audit results and trends to stakeholders, overseeing resource allocation and team development, and driving process improvements that enhance quality, compliance, and operational effectiveness.
Requirements
- Bachelor's degree in related field or equivalent experience.
- 5+ years of public accounting, internal audit, or related operational experience.
- Knowledge of Microstrategy, ACL, Compliance 360, Microsoft Applications (including Excel and Access), Tableau, and claims payment systems preferred.
Nice To Haves
- CPA, CIA, CISA preferred.
Responsibilities
- Oversee various operational audits within multiple functional areas including claims, provider set up and maintenance, member eligibility, contracting, encounters, provider/member services and new business implementation.
- Oversee monthly claims audit management reporting.
- Manage full life cycle of claims audit reporting and upstream operational audits including business requirement gathering, creation of audit work plan and schedule, managing resources (both Operational and Claims Audit teams), managing budget, facilitation of audit execution and reporting through closure of audit period and/or operational audit.
- Effectively communicate audit results to leadership and other corporate and health plan stakeholders.
- Evaluate corporate and health plan operational processes and/or controls to identify non-compliant issues and improvement opportunities.
- Maintain audit tools to ensure that all business requirements are appropriately measured during audits.
- Coordinate cross functional corrective action plan meetings to ensure continued claims quality improvements as a result of audit findings.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Manager
