You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.
**Position Purpose:** As part of Payment Integrity Compliance team, you'll ensure compliance with contractual requirements and federal and state government reporting and regulations. Maintain government relations for compliance activities. Conduct investigations of fraud and abuse issues.
***Note:** Qualified candidates **_must_** reside in Florida. This is a hybrid position as there is an in-person element to the job. This will include traveling to the South Florida office once a month for team/department meetings, trainings. Therefore, candidates should be located in the greater South Florida area.
**Essential Responsibilities:**
+ Ensure compliance with contract provisions with various agencies and applicable State and Federal laws.
+ Engagement of providers, members, and other business partners during investigations.
+ Write investigation reports.
+ Coordinate non-compliant activities with government entities.
+ Serve as compliance resource for dayto-day processes.
+ Analyze and determine the best course of action for each inquiry/problem by reviewing plan and agency/state guidelines as they apply to the investigations.
+ Act as primary contact for initiating and coordinating compliance projects.
+ Develop and update plan policies and procedures to ensure compliance with federal and state requirements.
+ Conduct periodic assessments and audits to ensure compliance with contractual and regulatory requirements and timeliness of submission.
+ Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance.
**Education/Experience:**
+ Bachelors degree in related field or equivalent experience.
+ 5+ years of compliance or regulatory experience.
+ Advanced experience with Microsoft Office applications (Excel, Power Point).
+ Knowledge of business operations related to managed care preferred.
+ Knowledge in compliance government programs preferred.
**Pay Range:** $67,400.00 - $121,300.00
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.
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