Operations Auditor

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.

Location Requirement:
To be considered for this opportunity, candidates must reside in the state of Kansas. Applicants who reside in Kansas City, Missouri are also eligible for consideration.

Work Schedule:
This is a fully remote position with a standard Monday through Friday schedule, 8:00 AM to 5:00 PM CST.

Position Purpose: Audit systems entry, performance metrics and work processes for assigned functions

• Audit accuracy of new group set-ups, existing contract changes, group terminations
• Design, implement, and manage data review processes to ensure accuracy and integrity of PDM/Credentialing data reports to meet regulatory and operational requirements
• Execute risk based audits evaluating controls and processes for scalability, efficiency, and risk mitigation strategies
• Compile audit findings and report to management, making recommendations for modifications and improvements to operations, systems and procedures via work plans, graphs and reporting metrics
• Ensure defined goals are implemented and relevant supporting documents are available to measure goal performance
• Coordinate auditing outcomes to identify, develop and publish corrective actions and educational material related to audit errors
• Examine and evaluate information systems, recommending controls to ensure system reliability and data integrity
• Identify and resolve system issues with data load
• Research state contract requirements and accrediting body standards and identify areas that present potential risk to the company
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s degree in related field, or equivalent experience. 3+ years of auditing or process improvement experience, preferably in a managed care setting. Knowledge of state contract and accreditation requirements.

Preferred Qualifications:

• Experience with LTSS, Home- and Community-Based Services, case management, managed care, HEDIS, or KDADS-related audit activities.
• Prior experience auditing case files, reviewing documentation, identifying trends, and recommending process improvements.
• Strong attention to detail, organizational skills, time management, and ability to work independently in a remote environment.

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Originally posted on Himalayas