Senior Compliance Investigator

Company: Centene Corporation
Location: New York
Posted on: November 1, 2024

Job Description:

Job Summary:

As a key member of the Centene Corporation team, you will oversee a full range of waste, abuse, and fraud investigations, audits, and medical code editing scenarios. Your expertise will ensure all audits adhere to federal and state Medicaid fraud, waste, and abuse guidelines. You will also oversee the activities of the Special Investigations Unit (SIU) for accurate and timely operational reviews and final reviews. Additionally, you will interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks. You will develop and implement continuous auditing processes from analytic design to final report stage, identify and direct the implementation of new technologies, and ensure compliance with all state and federal regulations for fraud and abuse. You will also respond to all legal inquiries, including subpoenas and court appearances, and attend federal CMS and state fraud meetings with other managed care organizations and state and federal employees.

Requirements:
A Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management, or a related field, or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS. This is a remote position, but due to contract requirements, the candidate must reside within the state of New York. Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K, and stock purchase plans, tuition reimbursement, paid time off, plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Centene Corporation, Philadelphia , Senior Compliance Investigator, Accounting, Auditing , New York, Pennsylvania