Director, Special Investigations Prepay Unit
You could be the one who changes everything for our 28 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. Applicants for this role have the flexibility to work remotely anywhere in the Continental United States. Position Purpose: Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines.
- Oversee the activities of the SIU 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 auditing processes from analytic design to final report stage
- Identify and direct the implementation of new technologies
- Ensure compliance with all state and federal regulations for fraud and abuse
- Respond to all legal inquiries including subpoenas and court appearances
- Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees
Education/Experience:
- Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent.
- 7+ years of related compliance and/or special investigation experience in managed care or CMS.
Pay Range: $118,400.00 - $219,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job