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Manager, Special Investigation Unit (SIU)

Chesterfield, Missouri Apply Now Job ID 1143538 Category Compliance Organization Centene Corporation Schedule Full-time
Description:
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.

  • Monitor business processes and systems to assure integrity and compliance in billing and claims payment
  • Lead a team appropriately investigate all possible fraud, waste and abuse referrals
  • Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
  • Attend state/federal meetings as required by specific contracts
  • Review post-payment cases with appropriate parties to obtain refund
  • Prepare and distribute monthly and quarterly saving reports
  • Participate in Appeals Committee, work groups and interdepartmental meetings
Qualifications:
Education/Experience: 

  • Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 
  • 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience.
  • Experience with a medical fraud control unit preferred
  • Thorough knowledge of medical terminology. 
  • Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred. 
  • Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.

License/Certification: Medical records or coding license preferred.

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.
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