Senior Manager, Payment Integrity – Data Mining Programs
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Job Description
Senior Manager overseeing payment integrity data mining, vendor cost recovery, and cost containment programs at Centene. Partnering with health plans to reduce healthcare costs and deliver savings targets.
Responsibilities:
- Oversee and monitor internal and external cost recovery and cost containment initiatives against project metrics and forecasted recovery and cost avoidance goals for each Health Plan
- Manage internal and external vendors’ cost avoidance and cost recovery initiatives
- Partner with health plans and national vendors to identify and contain costs across recovery categories
- Develop annual budgets and projected targets for each national vendor and assist vendors in achieving projected annual savings
- Evaluate and streamline existing processes and implement new cost-reduction processes
- Present trends and cost containment opportunities, recommend action plans, and assist with implementation
- Assist health plans in understanding cost recovery rules, regulations, and processes
- Monitor other departments’ performance and processes and evaluate them for cost recovery
- Compile and present reporting packages for Senior Management on cost avoidance and cost recovery initiatives
- Perform other duties as assigned
- Comply with all policies and standards
Requirements:
- Bachelor’s degree in Accounting, Finance, Healthcare Management, related field, or equivalent experience
- 6+ years of data analysis, finance, or accounting experience
- Experience with government programs auditing and compliance monitoring programs preferred
- Project management experience preferred
- Comply with all policies and standards
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
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