Payment Integrity Business Partner II

Centene Management Company LLC; États-Unis; Hybride; USD 90 000 - 130 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Health insurance

401K/stock purchase plans

Tuition reimbursement

PTO + holidays

Flexible work arrangements

Résumé du poste

Centene Management Company LLC is seeking a Payments Integrity Business Partner to act as a liaison across Medicaid, Medicare, Marketplace, and other lines of business. You will drive payment accuracy, vendor performance, and stakeholder engagement while coordinating across clinical, analytics, compliance, and operations teams.

Ideal candidates bring a Bachelor's degree with 3+ years in healthcare operations or related fields and strong experience influencing cross-functional teams.

Qualifications

• Requires a Bachelor's degree and 2–4 years of related experience, or equivalent experience.
• 3+ years in healthcare operations, managed care, claims, payment integrity, or vendor management.
• Experience influencing cross-functional teams and presenting to leadership.
• PMP and Lean Six Sigma certifications are strongly preferred.

Responsabilités

• Build and maintain relationships with market leadership, providers, vendors, and internal partners.
• Represent Payment Integrity in meetings, workgroups, governance forums, and initiatives.
• Communicate program performance, savings opportunities, and policy updates clearly to stakeholders.
• Support implementation of Payment Integrity initiatives and coordinate cross-team activities.
• Manage vendor relationships and monitor performance for improvement initiatives.
• Resolve stakeholder, regulatory, vendor, and operations issues with timely escalation.
• Analyze performance metrics to improve payment accuracy and stakeholder experience.
• Document decisions, risks, and follow-up actions for consistent execution.

Connaissances

Stakeholder management

Cross-functional collaboration

Analytics

Vendor management

Formation

Bachelor's degree

Description du poste

Position Purpose

The Payment Integrity Business Partner serves as a primary liaison between Payment Integrity and assigned health plans, lines of business, providers, vendors, and internal stakeholders. The role provides consultative support, facilitates issue resolution, communicates program performance and savings opportunities, and helps ensure alignment between Payment Integrity initiatives and business objectives. This position supports cross-functional collaboration across Medicaid, Medicare, Marketplace, and other lines of business, while helping advance payment accuracy, operational effectiveness, vendor performance, and stakeholder engagement. The role manages through difficult situations and projects, effectively solves problems, and influences stakeholders through clear explanation of facts, policies, and practices.

Key Details

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Serve as the primary point of contact for assigned health plans, markets, and stakeholders regarding Payment Integrity programs, initiatives, and issue resolution. Build and maintain working relationships with market leadership, providers, vendors, and internal business partners to support timely communication and alignment. Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives related to assigned markets or programs. Communicate program performance, savings opportunities, operational impacts, trends, and policy updates to stakeholders in a clear and actionable manner. Support implementation of Payment Integrity initiatives and coordinate activities across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams. Manage assigned vendor relationships, monitor performance, and support revenue-enhancement and operational improvement initiatives within assigned scope. Facilitate resolution of stakeholder, provider, regulatory, vendor, and operational issues, ensuring timely communication, follow-through, and appropriate escalation. Analyze performance metrics and identify opportunities to improve payment accuracy, operational effectiveness, and stakeholder experience. Document decisions, themes, risks, and follow-up actions to support consistent execution and visibility across Payment Integrity partners. Performs other duties as assigned. Complies with all policies and standards.

Responsibilities

Build and maintain working relationships with market leadership, providers, vendors, and internal business partners to support timely communication and alignment.

Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives related to assigned markets or programs.

Communicate program performance, savings opportunities, operational impacts, trends, and policy updates to stakeholders in a clear and actionable manner.

Support implementation of Payment Integrity initiatives and coordinate activities across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams.

Manage assigned vendor relationships, monitor performance, and support revenue-enhancement and operational improvement initiatives within assigned scope.

Facilitate resolution of stakeholder, provider, regulatory, vendor, and operational issues, ensuring timely communication, follow-through, and appropriate escalation.

Analyze performance metrics and identify opportunities to improve payment accuracy, operational effectiveness, and stakeholder experience.

Document decisions, themes, risks, and follow-up actions to support consistent execution and visibility across Payment Integrity partners.

Education & Experience

Requires a Bachelor's degree and 2-4 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 3+ years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related field required. Experience collaborating with and influencing cross-functional teams and business stakeholders required. Experience presenting information, updates, and recommendations to leadership or business partners required. Experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations preferred. Experience managing vendors, outsourced services, or external business partners preferred. Experience supporting provider, regulatory, compliance, audit, or revenue-enhancement activities preferred. Experience interpreting operational, financial, or performance data preferred.

License/Certification

Certified Project Management Professional (PMP)-PMI and/or Lean Six Sigma certification and related project, process improvement, or operational excellence experience strongly 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

Compensation

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.

Equal Opportunity and Diversity

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.

About Centene

At Centene, we connect people to the care they need to live healthier lives and the work you do here makes that impact real every day. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.