Senior Manager, Payment Integrity

Role Overview

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: Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan.

Responsibilities

• Support content coordination and quality oversight within Payment Integrity.
• Manage data mining programs.
• Manage internal and external vendors cost avoidance and cost recovery initiatives.
• Partner with health plans to identify and contain cost through collaboration with national vendors for each recovery category.
• Develop annual budget and projected target for each national vendor and assist them with achieving projected annual savings.
• Evaluate and streamline existing processes and implement new processes to reduce costs.
• Present trends and cost containment opportunities, recommend action plans, and assist with the implementation of those plans.
• Assist health plans in understanding the rules, regulations and processes around cost recovery.
• Monitor other departments’ performance and processes and evaluate for cost recovery.
• Compile and present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives.

Qualifications

• Bachelor’s degree in Accounting, Finance, Healthcare Management, related field or equivalent experience.
• 6+ years of data analysis, finance or accounting experience.
• Experience with government programs auditing and compliance monitoring programs preferred.
• Project management experience preferred.

Pay Range

$107,700.00 - $199,300.00 per year

Benefits

• 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.

Equal Opportunity Employer

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.