Senior Manager, Payment Integrity

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.

We will be looking for the following area's within Payment Integrity to be supported:

1.  Content Coordination & Quality Oversight

2.  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

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