Remote Payments Integrity Manager – FWA & Compliance Lead

Centene Management Company LLC

Missouri

Hybrid

USD 88,000 - 158,000

Full time

3 days ago

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Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work with remote, hybrid, or/

Job summary

Centene is seeking a Fraud, Waste and Abuse (FWA) leader in Missouri to develop, implement and manage strategic FWA activities within state and federal requirements. You will monitor trends, supervise analysts, and develop plans to meet contractual obligations; you will respond to RFPs and present the FWA program to regulators as needed.

The role requires a strong background in medical claim investigations, compliance, healthcare terminology, and prior managed care leadership experience.

Qualifications

Bachelor's degree and 4+ years in medical claim investigation, compliance or fraud and abuse.
Thorough knowledge of medical terminology.
Experience in a managed care environment and supervisory responsibilities preferred.

Responsibilities

Develop, implement and manage strategic FWA activities.
Monitor trends and schemes and ensure billing compliance.
Lead teams of analysts to investigate referrals.
Develop customized fraud plans to meet contracts and federal requirements.
Prepare and present the FWA program to state/federal personnel.

Skills

Fraud & abuse investigations

Leadership / supervision

Medical terminology

Education

Bachelor's degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience

Job description

The role requires a strong background in medical claim investigations, compliance, healthcare terminology, and prior managed care leadership experience.

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