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, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: With the Corporate Payment Integrity team, you will assist in researching CMS and State guidelines, claims editing and perform state specific reviews.

• Assist in the research, analysis, and resolution of claims compliance issues.

• Complete monthly, quarterly and annual reviews of current CMS and State guidelines for updates to ensure current PISCES edits align for compliance purposes.

• Maintain database and other reference materials related to legislative and regulatory issues and compliance.

• Communicate state and federal requirements to internal and external clients.

• Provide development guidance and assists in the identification, implementation, and maintenance of compliance policies, procedures and work instructions.

• Maintain and reviews regulatory documentation necessary to maintain corporate standards.

• Assist in developing, producing and conducting compliance training programs.

• Perform periodic compliance audits, risk assessments and conducts related ongoing compliance monitoring activities.

• Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members.

• Plan, direct and coordinate the implementation of Compliance Committee policy to ensure decisions are properly executed.

• Serve as a company wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives.

Education/Experience: Bachelor’s degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred and may be considered in lieu of experience. 1+ years of related experience in compliance, privacy and/or regulatory affairs. Working knowledge of laws and/or regulations in area of compliance; in particular HIPAA, and state regulations.

Preferred Skills:

Medical Billing and Coding

Appeals experience

Working with claims editing, researching guidelines

CPC/ CCS Certification

Communication skills (written, oral)

MS-Office (Word, Outlook, Excel, Power Point)

Flexible and a team player

Pay Range: $54,000.00 - $97,100.00 per year

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.