Senior Manager, Payment Integrity
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Job Description
Senior Manager overseeing Payment Integrity initiatives at Centene. Focused on cost recovery and containment for health plans with a data-driven approach.
Responsibilities:
- 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
- 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
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
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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