Payment Integrity Specialist - Regulatory

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:
The Senior Business Process Consultant leads business case development for proposed initiatives, supports the strategic planning process, and leads larger scale, cross-functional initiatives.

• Leads business case development for proposed initiatives to ensure adequate assessment of opportunities, risks and return on investment.
• Provides input and supports planning and prioritization of initiatives as part of the strategic and business planning process.
• Ensures that initiatives support the strategic business plan, meet key business objectives and are executed well tactically.
• Ensures that all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative).
• Leads larger scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance.
• Provides strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results.
• Organizes work teams, drives consensus and ensures end to end policy/process integrity to accomplish project work: including identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight.
• Performs detailed analysis of data, workflows, policies, procedures, organization of staff, and skills in order to execute initiatives.
• Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project.
• Leads all levels of staff who are responsible for initiatives included in the companies operating plan in order to support their success, development and effective completion and communication of their initiative.
• Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc.
• Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives.
• Provides other related support as needed to improve the performance of the business
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in a related field or equivalent experience required
Master's Degree in a related field preferred
6+ years managing projects required
Experience in health care and/or insurance preferred


Licenses/Certifications:
Certified Project Management Professional (PMP)-PMI required
Process quality certification preferred

Certified Project Management Professional (PMP)-PMI For Health Net and Enterprise Business Operations only preferred:

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