Company

Centene Corporation

Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines.

Oversee the activities of the SIU for accurate and timely operational reviews and final reviews
Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks
Develop and implement continuous auditing processes from analytic design to final report stage
Identify and direct the implementation of new technologies
Ensure compliance with all state and federal regulations for fraud and abuse
Respond to all legal inquiries including subpoenas and court appearances
Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees

Education/Experience Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS.

IMPORTANT NOTE This candidate must live within the state of New York or within close commuting distance of our Long Island City office per contract requirements. This will be a remote role with occasional meetings held in office.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Pay Range $111,600.00 - $206,400.00 per year

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Identifier

5be205b681ca39fd8dc870e17c00a6ef