Director, Payment Integrity

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:** Oversee prepay waste and abuse reviews through coding, editing, and audit programs. Provide guidance and set policies to ensure all programs adhere to state and federal regulations as well as company policies.

+ Oversee prepay editing and retrospective audits to ensure accurate and timely payments of coding and pricing issues
+ Interpret audit results, develop action plans and present findings to senior management
+ Develop and implement continuous processes from analytic design to final report stage
+ Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures
+ Monitor laws and regulations that may im...