Director, Payment Integrity & Appeals (Remote)

Centene Corporation; Illinois; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Stock purchase plan

Tuition reimbursement

Job summary

Centene Corporation in Illinois seeks a Senior Prepay Compliance Manager to oversee prepay waste and abuse reviews, coding, editing, and audit activities to ensure timely, accurate payments and adherence to state and federal regulations.

The role leads a team, interprets audit results, and develops action plans while designing internal payment integrity programs and providing training to providers and staff.

Qualifications

• Bachelor’s degree in accounting/finance or healthcare field, with 7+ years of related experience.
• Experience in finance, accounting, operations, or auditing; claims operations preferred.
• Experience in compliance or risk management advantageous.

Responsibilities

• Oversee prepay editing and retrospective audits for accurate payments.
• Interpret audit results, develop action plans, present to senior management.
• Develop and implement continuous analytical processes from design to final report.
• Design and implement internal payment integrity edit programs and procedures.
• Monitor laws and regulations impacting payment integrity; ensure compliance.
• Recommend process improvements to support strategic initiatives.
• Develop and deliver training programs for providers and employees.
• Direct and lead Prepay Compliance Managers.
• Perform other duties as assigned.
• Complies with all policies and standards.

Skills

Prepay waste and abuse reviews

Audit programs

Regulatory compliance

Leadership

Education

Bachelor’s degree in accounting or related field

Job description

Centene Corporation in Illinois seeks a Senior Prepay Compliance Manager to oversee prepay waste and abuse reviews, coding, editing, and audit activities to ensure timely, accurate payments and adherence to state and federal regulations.

The role leads a team, interprets audit results, and develops action plans while designing internal payment integrity programs and providing training to providers and staff.