You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Identify and implement process improvements for various functions, including new business implementation, claims and encounters performance, benefit specifications, and system integrity.
- Identify and manage the system and business requirements for new and existing business and ensure that performance meets all health plan, state, and provider contract requirements
- Research, define, and manage business specifications for creating system infrastructures for new market builds and identify and maintain specifications to accommodate changes for existing markets based on regulatory or business changes.
- Monitor system performance and accuracy, ensuring metrics for provider load, claims processing, encounter submission, and other similar functions are met
- Identify systematic solutions for internal and external stakeholders regarding requirements or business needs and ensure solutions are put into production
- Initiate and manage special projects to improve processes to increase efficiency, productivity, and accuracy across the organization
- Design provider contract rate exhibits and implement negotiated contracts
- Create, maintain and approve reports for contractual obligations and monitor performance
- Create and maintain additional reference documentation regarding market specific setup and operational processes, including policies and procedures
Education/Experience: Bachelor's degree in related field or equivalent experience. Master’s degree preferred. 5+ years of health care operations, system administration, product/program management, or claims administration experience. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Contract negotiation or management experience preferred.
Pay Range: $86,000.00 - $154,700.00 per year
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. Total compensation may also include additional forms of incentives.
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
