Program Manager II - Medicare/Marketplace Claims

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: This Program Manager II will support AZ Complete Health as they will plan, organize, monitor, and oversee programs utilizing cross functional teams to deliver defined requirements and meet business needs and strategic objectives.

The ideal candidate for this Program Manager II role will have a strong background in project management, data analysis, and healthcare operations (emphasis on claims and configuration), with expertise in Medicare and Marketplace programs. They should be skilled in driving cross-functional collaboration, analyzing complex data to support decision-making, and identifying process improvements that enhance efficiency and compliance.

In this Program Manager II role, you will: 

• Leverage data analysis skills to run queries, pull claims data, and identify trends, providing insights that support decision-making and issue resolution
• Apply working knowledge of billing and reimbursement rules, specifically for Medicare and Marketplace, to support claims analysis and ensure program compliance.
• Serve as the primary liaison between Provider Engagement, Internal Medicare Operations/Value Based team, and Shared Services, ensuring alignment and effective collaboration across these areas.
• Ensure that all Medicare and Marketplace deliverables, including claim-related metrics, reference materials, and policies/procedures, meet quality and turn-around standards.
• Drive process improvements by identifying gaps in existing procedures and collaborating with teams to implement changes that enhance efficiency and outcomes
• Support claims issue resolution by identifying trends, troubleshooting escalated claims concerns, and working with internal teams to ensure timely and accurate claims processing.
• Support business department initiatives that promote, quality, safety and cost of care opportunity
• Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment.
• Utilize corporate and industry standard tools and techniques to effectively oversee programs according to department procedures.
• Maintain detailed business process documentation including meeting minutes, action items, issues lists and risk management plans as applicable
• Create and monitor all department deliverables to ensure adherence to quality standards including clinical reporting documents, related reference materials, and policy and procedure documentation.
• Communicate program status to management and key stakeholders.
• Identify resources, resolve issues, and mitigate risks.
• Identify requirements, procedures and problems to improve existing processes
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business objectives
• …