Director, Special Investigative Unit (SIU)
Company Name:
Centene
## Description
Position Purpose: Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines.
Oversee the activities of the SIU for accurate and timely operational reviews and final reviews
Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks
Develop and implement continuous auditing processes from analytic design to final report stage
Identify and direct the implementation of new technologies
Ensure compliance with all state and federal regulations for fraud and abuse
Respond to all legal inquiries including subpoenas and court appearances
Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees
## Qualifications
Education/
Experience: Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent. 7
years of related compliance and/or special investigation experience in managed care or CMS.
## Job
Job: Compliance
Primary Location: USA-Missouri-Clayton
Other Locations: USA-Missouri-Chesterfield
Organization: Compliance SIU
Schedule: Full-time
Req ID: 1002629Estimated Salary: $20 to $28 per hour based on qualifications.
Centene
## Description
Position Purpose: Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios. Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines.
Oversee the activities of the SIU for accurate and timely operational reviews and final reviews
Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks
Develop and implement continuous auditing processes from analytic design to final report stage
Identify and direct the implementation of new technologies
Ensure compliance with all state and federal regulations for fraud and abuse
Respond to all legal inquiries including subpoenas and court appearances
Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees
## Qualifications
Education/
Experience: Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent. 7
years of related compliance and/or special investigation experience in managed care or CMS.
## Job
Job: Compliance
Primary Location: USA-Missouri-Clayton
Other Locations: USA-Missouri-Chesterfield
Organization: Compliance SIU
Schedule: Full-time
Req ID: 1002629Estimated Salary: $20 to $28 per hour based on qualifications.
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