Job Description

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Applicants for this role will have the flexibility to work remotely anywhere in the Continental United States. Position Purpose: Direct and oversee claims audit operations and medical code editing scenarios. Oversee payment integrity operations, including pilots, new business, transformative initiatives, and payment policies. Develop and execute Payment Integrity strategies, end-to-end process automation, optimization and management. Oversee various functions of the Payment Integrity department for accurate and timely operational reviews and final reviews. Develop corporate policies and procedures and implement corporate initiatives. Identify and prioritize analytical gaps between the current-state and industry best practices; implement solutions to generate business value. Chart the course for integration activities related to payment integrity and other assigned functions in alignment with organization objectives. Education/Experience: Bachelor's Degree in Business Administration, Finance, Accounting, Criminal Justice, Economics or related field required. Master's Degree preferred. 10+ years of Managed Care or CMS related experience, including compliance, claims, payment integrity, or special investigation experience required. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Pay Range: $223,200.00 - $422,900.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act #J-18808-Ljbffr Centene Corporation

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