Director, Payment Integrity & Disputes

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

Benefits offered by this job

Remote work options

Hybrid work schedule

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene Corporation is seeking leadership over prepay waste and abuse reviews, guiding coding, editing, and audit programs to ensure compliance with state and federal regulations. You will oversee audits, develop action plans, and present findings to senior management.

The role emphasizes developing continuous processes, implementing payment integrity programs, and training providers and employees to streamline operations while maintaining policy adherence.

Qualifications

• Bachelor's degree or equivalent in a related field.
• 7+ years in finance, accounting, operations, or auditing.
• Experience in claims operations preferred.
• Strong knowledge of state and federal regulations.

Responsibilities

• Oversee prepay editing and retrospective audits for accurate payments.
• Interpret audit results and present findings to senior management.
• Develop and implement end-to-end analytic and reporting processes.
• Design and implement internal payment integrity edit programs and policies.
• Monitor laws and regulations affecting payment integrity and ensure compliance.
• Recommend process improvements to support strategic initiatives.
• Develop and deliver training for providers and employees.
• Direct Prepay Compliance Managers to reduce waste, abuse, and fraud.
• Perform other duties as assigned.
• Comply with all policies and standards.

Skills

Prepay auditing

Policy development

Leadership

Training delivery

Regulatory compliance

Data analysis

Education

Bachelor's degree in Accounting, Finance, Nursing, Operations Management, Healthcare related, or related field

Job description

Centene Corporation is seeking leadership over prepay waste and abuse reviews, guiding coding, editing, and audit programs to ensure compliance with state and federal regulations. You will oversee audits, develop action plans, and present findings to senior management.

The role emphasizes developing continuous processes, implementing payment integrity programs, and training providers and employees to streamline operations while maintaining policy adherence.