Director, Payment Integrity - Edit Programs

Centene
Missouri
Workplace: RemoteFull timeUSD 118,400 - 219,000 annuallyFunction: Executive & General ManagementExperience: 7+ yearsEducation: bachelorsSkills: ["Compliance","Audit interpretation","Process improvement","Policy development","Training delivery"]

Oversee prepay waste and abuse reviews by leading coding, editing, and audit programs that ensure accurate, timely payments and strict adherence to state and federal regulations. Interpret audit results to develop action plans, design internal payment integrity policies and procedures, and implement continuous processes from analytics through final reporting. Monitor regulatory changes, recommend improvements for strategic initiatives, deliver provider and employee training, and lead Prepay Compliance Managers.

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Centene
Centene
1 day ago

Director, Payment Integrity - Edit Programs

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Oversee prepay waste and abuse reviews by leading coding, editing, and audit programs that ensure accurate, timely payments and strict adherence to state and federal regulations. Interpret audit results to develop action plans, design internal payment integrity policies and procedures, and implement continuous processes from analytics through final reporting. Monitor regulatory changes, recommend improvements for strategic initiatives, deliver provider and employee training, and lead Prepay Compliance Managers.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Executive & General Management
Seniority: Director level

Key Responsibilities

  • •Oversee prepay editing and retrospective audits to ensure accurate, timely payments of coding and pricing issues.
  • •Interpret audit results, develop action plans, and present findings to senior management.
  • •Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures.
  • •Monitor laws and regulations impacting payment integrity and implement changes while maintaining compliance with state and federal requirements.
  • •Direct and lead Prepay Compliance Managers and develop/ deliver educational training to providers and employees to streamline operational processes.

Pay and Benefits

Salary: USD 118,400 - 219,000 annually
Perks:Health Insurance401kEquityRemote Work

Key Requirements

  • •Bachelor’s degree in Accounting, Finance, Nursing, Operations Management, Healthcare-related, or a related field, or equivalent experience.
  • •7+ years of finance, accounting, operations, or auditing experience.
  • •Experience in claims operations preferred.
  • •7+ years of compliance/ERM experience preferred.
  • •Ability to direct and lead Prepay Compliance Managers and educate providers and employees.
Experience:7+ years
Education:Bachelor's
Skills:ComplianceAudit interpretationProcess improvementPolicy developmentTraining delivery

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn