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Centene is seeking a Manager for Payment Integrity with a focus on fraud, waste, and abuse in healthcare billing and claims. The ideal candidate will have significant experience in medical claim investigations and compliance, as well as strong leadership skills.
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Job Summary
The role involves developing and managing strategic fraud, waste, and abuse activities to maintain state and federal requirements while monitoring trends and schemes.
Candidates will lead teams of analysts to investigate fraud referrals and prepare monthly and quarterly saving reports for the organization.
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, and flexible work schedules.
Matching Summary
Match Score: 75
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Centene is seeking a Manager for Payment Integrity with a focus on fraud, waste, and abuse in healthcare billing and claims. The ideal candidate will have significant experience in medical claim investigations and compliance, as well as strong leadership skills.
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Salary
Base: $87,700.00 - $157,800.00 per year; Bonus/Equity: Additional forms of incentives may apply; Benefits: Health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off
Skills & Requirements
Must-have
Medical claim investigation experience
Fraud waste and abuse monitoring
State and federal compliance knowledge
Thorough medical terminology knowledge
Billing and claims payment integrity
Nice-to-have
Managed care environment experience
Staff hiring and performance management
Microsoft Excel and data mining skills
Medical coding license preferred
Customized fraud plan development
Key Requirements
Bachelor's degree in Business, Healthcare, or Criminal Justice
4+ years of medical claim investigation or compliance experience
Previous experience as a lead or supervisor of staff
Knowledge of Microsoft Excel, medical coding, and claims processing