Manager, SIU Prepay Investigations
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Florida • Montana • United States
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Salary
💰 $87,700 - $157,800 per year
About the role
- Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes
- Monitor business processes and systems to assure integrity and compliance in billing and claims payment
- Lead a team appropriately investigate all possible fraud, waste and abuse referrals
- Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
- Attend state/federal meetings as required by specific contracts
- Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies
- Prepare and distribute monthly and quarterly saving reports
- Participate in Appeals Committee, work groups and interdepartmental meetings
Requirements
- Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience
- 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience
- Thorough knowledge of medical terminology
- Previous experience as a lead or supervisor in a pre-payment process managing cross functional teams or supervisory experience including hiring, training, assigning work and managing the performance of staff preferred
- Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred
- Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) preferred
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 & Tools
medical claim investigationfinancial impact analysisbusiness analysiscompliancefraud and abusemedical terminologymedical codingclaims processingdata mining
Soft Skills
leadershipteam managementcommunicationtrainingperformance management
Certifications
Accredited Health Care Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)