Manager, Payment Integrity - Implementations

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: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements.

• Lead teams of Project Managers to implement cost savings initiatives
• Responsible for coordination of health plan decision, necessary exclusions, letterset review, state / regulatory review, provider notification, and configuration of a policy or program.
• Primary point of contact for the Health Plan.
• Facilitate and lead Monthly Touchpoint Calls with each plan 
• Map out and follow-up on Implementation timeframes. 
• Act as the liaison on Q&A between the plan and Payment Integrity Subject Matter Experts.
• Track financial impact revisions due to exclusions. 
• Coordination of letterset review, state / regulatory review, and provider notification.
• Track implementation decisions. 
• Submit configuration requests and communicate upon go-live.

Education/Experience:

• Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
• 4+ years of medical claim investigation, compliance or fraud and abuse experience.
• 4+ years of project management or account management in healthcare strongly preferred.
• Thorough knowledge of medical terminology required.
• Payment Integrity experience strongly preferred.
• Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred.
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining 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. 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