Job ID 1098702Date posted 05/16/2018Category ComplianceOrganization Centene CorporationSchedule Full-timeDescription:Position Purpose: Investigate allegations of healthcare fraud and abuse activity. Assist in planning, organizing, and executing special claims investigations or audits that identify, evaluate and measure potential healthcare fraud.Assist in monitoring business processes and systems to assure integrity and compliance in billing and claims paymentInvestigate possible waste , abuse and fraud leads and document activity on each lead and refer issues to the appropriate partyDevelop internal reports to identify potential waste, abuse and fraudPerform data mining and analysis to detect aberrancies and outliers in claimsServe as point of contact for corporate and field inquiries regarding waste, abuse and fraudReview post-payment cases with appropriate parties to obtain refundProvide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutionsPrepare summary and detailed reports on investigative findings for referral to Federal and State agenciesArrange, conduct, and attend meetings with providers, business partners, and representatives from regulatory agencies and law enforcement regarding investigationsQualifications:Education/Experience: Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 3 years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience. Knowledge of Microsoft Applications medical coding, claims processing, and data mining preferred. Licenses/Certifications: Certified Professional Coder preferredCentene 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.
Website : http://www.centene.com
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations