Manager, Payment Integrity - Readmissions

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Overview

Centene Corporation is inviting applications for a Manager, Payment Integrity - Readmissions role that emphasizes transforming healthcare by ensuring the integrity of claims payments and compliance. This position will have a profound impact on the well-being of 28 million members by addressing issues related to fraud, waste, and abuse in health services.

Position Purpose

The primary responsibility of the Manager will be to develop, implement, and oversee strategic activities aimed at combating fraud, waste, and abuse. This role requires maintaining adherence to state and federal regulations while monitoring trends and schemes relevant to healthcare billing. The ideal candidate will lead teams of analysts in investigating fraud referrals and create custom fraud plans compliant with both state and federal requirements.

The job entails responding to Requests for Proposals (RFPs) and implementing new policies based on contractual obligations. Additionally, the manager will prepare and present the fraud, waste, and abuse (FWA) program to state and federal officials during readiness reviews and other essential meetings. The incumbent must also prepare accurate monthly and quarterly reports which highlight cost savings to the organization.

Required Skills and Experience

Education Background

• A Bachelor's degree in fields like Business, Healthcare, or Criminal Justice is essential.
• Equivalent experience may substitute for formal education.

Relevant Experience

• At least 4 years of experience specifically in medical claim investigations, compliance, or fraud and abuse.
• Familiarity with medical terminology is critical for effective performance in this role.
• Previous exposure to a managed care environment is highly recommended, particularly in leadership roles.

Technical Skills

• Proficiency in Microsoft Excel is preferred, as this will aid in data analysis.
• Understanding of medical coding, claims processing, and data mining will be advantageous.

Leadership Skills

• Experience in leading, supervising, hiring, and training staff is a plus. The role involves managing performance and assigning work to team members, thereby necessitating strong leadership capabilities.

Compensation and Benefits

The pay range for this role is competitive, falling between $87,700.00 and $157,800.00 annually. The specific salary will be adjusted based on individual factors such as skills, experience, education, and job-related criteria allowed by law. In addition to the base salary, there are various forms of incentives that may be offered, contributing to overall compensation.

The benefits package includes:

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible working environment, with options for remote, hybrid, field, or office work schedules.

Company Commitments

Centene Corporation is dedicated to fostering a diverse and inclusive workplace. They affirm that all applicants will receive equal consideration for employment, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Moreover, individuals with arrest or conviction records are encouraged to apply, in alignment with the Los Angeles County Ordinance and the California Fair Chance Act.

Conclusion

In conclusion, the position of Manager, Payment Integrity - Readmissions at Centene Corporation offers a significant opportunity for professionals interested in making impactful changes in the healthcare system while ensuring compliance and integrity in payment processes. The requirements and benefits associated with this role provide a comprehensive understanding of what potential candidates should expect should they decide to apply.

This job offer was originally published on himalayas.app