Director, Payment Integrity
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Montana • United States
Visit company websiteExplore more
Salary
💰 $118,400 - $219,000 per year
Job Level
About the role
- Oversee prepay waste and abuse reviews through coding, editing, and audit programs
- Provide guidance and set policies to ensure all programs adhere to state and federal regulations as well as company policies
- 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
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
- Compliance/ERM: 7+ years experience 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
codingeditingaudit programspayment integrityprocess improvementanalytic designclaims operationsfinancial auditingcompliance managementreporting
Soft Skills
guidancepolicy settingcommunicationleadershiptraining developmentstrategic initiative executionproblem-solvinganalytical thinkingpresentation skillsteam management