Operations Auditor

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🔥 0 minutes ago

🌪️ Kansas – Remote

🌪️ Kansas – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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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

• Audit systems entry, performance metrics, and work processes for assigned functions • Audit accuracy of new group set-ups, existing contract changes, and group terminations • Design, implement, and manage data review processes for PDM/Credentialing data reports • Execute risk-based audits evaluating controls and processes for scalability, efficiency, and risk mitigation • Compile audit findings and report to management with recommendations for operational, system, and procedural improvements • Ensure defined goals are implemented and supporting documents are available to measure performance • Coordinate auditing outcomes to develop and publish corrective actions and educational materials related to audit errors • Examine and evaluate information systems and recommend controls for system reliability and data integrity • Identify and resolve system issues involving data loads • Research state contract requirements and accrediting body standards to identify potential risks • Perform other assigned duties and comply with policies and standards

🎯 Requirements

• Bachelor’s degree in a related field, or equivalent experience • 3+ years of auditing or process improvement experience • Knowledge of state contract and accreditation requirements • Experience preferably in a managed care setting • Experience with LTSS, Home- and Community-Based Services, case management, managed care, HEDIS, or KDADS-related audit activities preferred • Prior experience auditing case files, reviewing documentation, identifying trends, and recommending process improvements preferred • Strong attention to detail, organizational skills, and time management • Ability to work independently in a remote environment

🏖️ 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