Director, Payment Integrity - Health Plan Concierge at Centene

This role is designed for a seasoned healthcare leader with at least 8 years of experience in Payment Integrity (PI) or managed care operations. The ideal candidate has a deep understanding of reimbursement methodologies and a proven track record of managing complex provider relationships. You should be comfortable navigating a matrixed corporate environment and translating dense technical data into clear, actionable strategies for both internal executives and external providers. Centene offers a highly competitive salary range reaching up to $219k, supplemented by a comprehensive benefits package that includes stock purchase plans and tuition reimbursement. This is a fully remote position (Remote-MO), offering significant workplace flexibility while still providing the influence of a national leadership role. **You might be a good fit if you:** * Have 3+ years of specific experience in pre-pay edits, post-pay audits, or FWA programs. * Excel at resolving high-stakes provider escalations and improving financial performance through claims accuracy. * Are well-versed in CMS, Medicaid, and Medicare regulatory requirements. * Can lead cross-functional teams across IT, Legal, Finance, and Clinical departments to drive operational excellence.