Manager, Provider Reimbursement Audit

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🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead a team responsible for end-to-end Medicare, Duals, and Marketplace audit activities, including planning, execution, reporting, and corrective action monitoring • Manage monthly executive reporting and communicate audit results and trends to stakeholders • Oversee resource allocation and team development • Drive process improvements that enhance quality, compliance, and operational effectiveness • Oversee operational audits across claims, provider setup and maintenance, member eligibility, contracting, encounters, provider/member services, and new business implementation • Oversee monthly claims audit management reporting • Manage the full life cycle of claims audit reporting and upstream operational audits from requirements gathering through audit closure • Manage audit work plans, schedules, resources, and budgets • Facilitate audit execution and reporting through closure of audit periods and operational audits • Communicate audit results to leadership and corporate and health plan stakeholders • Evaluate operational processes and controls to identify non-compliance and improvement opportunities • Maintain audit tools to ensure business requirements are measured during audits • Coordinate cross-functional corrective action plan meetings to support claims quality improvements

🎯 Requirements

• Bachelor's degree in a related field or equivalent experience • 5+ years of public accounting, internal audit, or related operational experience • Knowledge of MicroStrategy, ACL, Compliance 360, Microsoft applications including Excel and Access, Tableau, and claims payment systems preferred • CPA, CIA, or CISA preferred

🏖️ Benefits

• 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