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Manager, Payment Integrity
Centene Corporation. Develop, implement and manage strategic fraud, waste and abuse activities while maintaining state and federal requirements and monitoring trends/schemes .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in developing and managing fraud, waste, and abuse programs while ensuring compliance with state and federal regulations. Proficient in medical claim investigation, team leadership, and the preparation of educational materials and reports.
Highest-signal resume keywords
Fraud, Waste, And Abuse ManagementMedical Claim InvestigationCompliance MonitoringTeam LeadershipMedical Terminology
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Fraud InvestigationClaims Payment IntegrityData AnalysisReport PreparationRegulatory Compliance
Soft Skills
Team ManagementCommunicationTraining And Development
Certifications & Qualifications
Medical Records LicenseCoding License
Industry Keywords
Managed CareHealthcare ComplianceBilling IntegrityRFP ResponseContractual Obligations
About the role
Key responsibilities & impact- Develop, implement and manage strategic fraud, waste and abuse activities while 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 investigating possible fraud, waste and abuse referrals
- Develop customized fraud plans to meet contract and federal requirements
- Develop educational materials to identify and validate waste activities
- Respond to RFP requests and implement new policies per contractual obligations
- Attend state and federal meetings as required by specific contracts
- Prepare and present the FWA program to state and federal personnel during readiness reviews, after go-live, or upon state agency personnel changes
- Review post-payment cases to obtain refunds
- Prepare and distribute monthly and quarterly savings reports
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- 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
- Previous experience in a managed care environment preferred
- Previous experience as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred
- Medical records or coding license preferred
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity