Manager,PaymentIntegrity

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:** Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes * Monitor business processes and systems to assure integrity and compliance in billing and claims payment * Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals * Develop customized fraud plans to meet contract and federal requirements * Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis * Respond to RFP request and implement new policies per contractual obligation * Attend state/federal meetings as required by specific contracts * Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes * Review post-payment cases with appropriate parties to obtain refund * Prepare and distribute monthly and quarterly saving reports **Education/Experience:** Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 4+ years of medical claim investigation, compliance or fraud and abuse experience. Thorough knowledge of medical terminology required. Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred. Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred. **License/Certification:** Medical records or coding license preferred. Pay Range: $87,700.00 - $157,800.00 per year Centene offers a comprehensi