Manager, Provider Reimbursement Audit

Centene
Missouri
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Finance & AccountingExperience: 5+ yearsEducation: bachelorsSkills: ["Communication","Stakeholder management","Process improvement","Cross-functional collaboration"]

Lead a team conducting end-to-end Medicare, Duals, and Marketplace audit activities, from audit planning and execution to reporting and corrective action monitoring. Manage monthly executive reporting and communicate audit results and trends to leadership and stakeholders. Oversee operational and claims audits across multiple functional areas, maintain audit tools, coordinate corrective action meetings, and drive process improvements to strengthen quality, compliance, and operational effectiveness.

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FursaFursa
Centene
Centene
1 day ago

Manager, Provider Reimbursement Audit

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

Job Summary

Lead a team conducting end-to-end Medicare, Duals, and Marketplace audit activities, from audit planning and execution to reporting and corrective action monitoring. Manage monthly executive reporting and communicate audit results and trends to leadership and stakeholders. Oversee operational and claims audits across multiple functional areas, maintain audit tools, coordinate corrective action meetings, and drive process improvements to strengthen quality, compliance, and operational effectiveness.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Finance & Accounting
Seniority: Manager level

Key Responsibilities

  • •Lead a team for end-to-end Medicare, Duals, and Marketplace audit activities including planning, execution, reporting, and corrective action monitoring.
  • •Manage monthly executive reporting and communicate audit results and trends to stakeholders.
  • •Oversee operational audits across functional areas such as claims, provider set up and maintenance, member eligibility, contracting, encounters, provider/member services, and new business implementation.
  • •Manage the full lifecycle of claims audit reporting and upstream operational audits, including requirements gathering, work plan scheduling, resource allocation, budget management, and audit closure.
  • •Evaluate operational processes/controls, maintain audit tools, and coordinate cross-functional corrective action plan meetings to drive claims quality improvements.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Equity and Bonus:Equity
Perks:Health Insurance401kEquityPaid LeavePaid HolidaysRemote Work

Key Requirements

  • •Bachelor's degree in a related field or equivalent experience.
  • •5+ years of public accounting, internal audit, or related operational experience.
  • •Knowledge of Microstrategy and ACL; Compliance 360 and Microsoft applications including Excel and Access.
  • •Knowledge of Tableau and claims payment systems (preferred).
  • •CPA, CIA, or CISA (preferred certifications).
Experience:5+ years
Education:Bachelor's
Skills:CommunicationStakeholder managementProcess improvementCross-functional collaboration
Certifications:CPACIACISA
Tech Stack:MicrostrategyACLCompliance 360Microsoft ExcelMicrosoft AccessTableauClaims payment systemsMicrosoft Applications

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