SIU Counsel


Cenpatico


Posted Under: Chesterfield, Missouri jobs in Accounting, Auditing; Accounting, Auditing jobs
Posted On: 2020-08-03 00:00:00

SIU Counsel USA-Missouri-Chesterfield Position Purpose: Responsible for reviewing regulations, RFPs and other documents affecting Fraud, Waste and Abuse (FWA) activities. Identify regulatory risk for the Special Investigations function and appropriately respond as needed. * Serve as a resource to various departments, including the Special Investigations Unit by assessing and translating complex legislation, rules and regulations into understandable information and facilitating analysis of compliance and implementation implications. * Collaborate with outside counsel and direct, monitor and develop legal strategies in connection with FWA litigation. * Organize and submit all Request for Production on FWA cases from governmental entities. * Create cross functional teams including legal, Special Investigations Unit, vendor delegation teams at the plan in order to ensure regulatory compliance with FWA functions. * Negotiate provider settlements and apply Corrective Action Plans in relation to FWA activities. * Review and draft policies and procedures in relation to FWA activities * Provide education and counseling on FWA procedures, schemes, legal analysis and political goals * Develop external contacts and participating in professional organizations that will provide benchmarks for FWA * Direct and conduct training and take preventative measures to ensure FWA compliance Education/Experience: * Graduate of an accredited law school. * 3+ years of related experience in a managed care related field and admitted into a state bar. * Knowledge of Medicare and/or Medicaid insurance, state insurance and HMO regulations preferred. * Fraud, Waste and Abuse experience preferred. License/Certificates: State Bar and currently in good standing 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. Compliance Full-time