Director, Special Investigative Unit – SIU
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida • 🇺🇸 United States
Visit company websiteSalary
💰 $116,100 - $214,700 per year
Job Level
Lead
About the role
- 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
Requirements
- 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
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
auditmedical code editingcompliancefraud investigationdata analysisreportingrisk assessmentcontinuous auditingoperational reviewsaction plan development
Soft skills
leadershipcommunicationorganizational skillsanalytical thinkingproblem-solvinginterpersonal skillsattention to detaildecision-makingcollaborationadaptability
Certifications
Certified Fraud Examiner (CFE)Certified Compliance and Ethics Professional (CCEP)Certified Internal Auditor (CIA)Certified Information Systems Auditor (CISA)Certified Healthcare Compliance (CHC)Certified Risk Management Professional (CRMP)Certified Public Accountant (CPA)Certified in Healthcare Compliance (CHC)Certified Information Systems Security Professional (CISSP)Certified Healthcare Financial Professional (CHFP)