Senior Director, Payment Integrity – Audit Programs

Centene Corporation

Provide strategic leadership for audit programs to enhance Payment Integrity at Centene. Lead the design and continuous improvement of audit strategies, methodologies, and performance standards.

Posted 5/3/2026full-timeRemote • Montana • 🇺🇸 United StatesSenior💰 $148,000 - $274,200 per yearWebsite

About the role

Key responsibilities & impact

Provide strategic leadership for the Audit Programs function within Payment Integrity
Lead the design, execution, and continuous optimization of prepayment and post payment audit programs that improve claims accuracy, reduce improper payments, and strengthen payment controls across all applicable lines of business
Establish the audit program roadmap, governance, methodologies, and performance standards
Oversee internal teams and external partners
Partner across the enterprise to implement solutions that deliver sustainable medical cost savings and operational excellence
Oversee clinical, coding, pricing, and policy audit activities to reduce improper payments and improve claims accuracy
Lead the identification, prioritization, and execution of audit opportunities aligned with financial and operational goals
Establish performance standards, metrics, and reporting to monitor audit effectiveness, savings, and operational health
Leverage data and analytics to identify trends, risks, and root causes of payment errors
Serve as a senior escalation point for complex audit findings, provider disputes, and operational challenges
Oversee external vendors supporting audit and recovery activities, ensuring quality, compliance, and performance accountability
Communicate audit results, risks, and recommendations clearly to senior leadership
Lead, develop, and mentor audit and clinical teams, fostering a culture of accountability and continuous improvement

Requirements

What you’ll need

Bachelor’s degree in Healthcare Administration, Nursing, Finance, Accounting, Business, Operations Management, or a related field required
Master’s degree in Business, Healthcare Administration, Public Health, or related field preferred
Candidates must hold Health Information Management or coding credentials such as RHIT, RHIA, CCS, CIC, or CCDS
A Registered Nurse (RN) or higher qualification, in combination with a coding credential, is preferred
10+ years of experience in Payment Integrity, healthcare auditing, claims operations, reimbursement methodologies, or managed care operations
5+ years experience managing prepay edits, postpay audits, or fraud, waste, and abuse programs required
3+ years experience in Medicaid and Medicare managed care plans strongly preferred
3+ years experience implementing PI technologies (analytics, automation, vendor platforms) is a plus
Proficiency in ICD-10-CM/PCS, MS-DRG, and APR-DRG

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

healthcare auditingclaims operationsreimbursement methodologiesprepay editspostpay auditsfraud programswaste programsabuse programsICD-10-CMMS-DRG

Soft Skills

strategic leadershipcommunicationmentoringaccountabilitycontinuous improvementcollaborationproblem-solvingdata analysisperformance monitoringgovernance

Certifications

RHITRHIACCSCICCCDSRegistered Nurse (RN)