Program Manager II - Medicare/Marketplace Claims

Arizona Complete Health; Washington (District of Columbia); Remote; USD 68,000 - 124,000; Full time

Job summary

Join a forward-thinking organization dedicated to transforming healthcare for millions. As a Program Manager II, you'll play a pivotal role in enhancing operational efficiency and compliance within Medicare and Marketplace programs. This position offers the chance to leverage your project management and data analysis expertise, collaborating with cross-functional teams to drive impactful initiatives. With a focus on continuous improvement, you'll identify trends, support claims resolution, and ensure quality deliverables. Enjoy a flexible work environment and comprehensive benefits while making a meaningful difference in the lives of others.

Benefits

Health Insurance

401K

Stock Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Options

Qualifications

• Strong background in project management and data analysis.
• Expertise in Medicare and Marketplace programs.

Responsibilities

• Oversee programs to meet business needs and strategic objectives.
• Drive process improvements and support claims issue resolution.

Skills

Project Management

Data Analysis

Healthcare Operations

Claims Analysis

Process Improvement

Education

Bachelor's degree in a related field

3+ years of project management experience

Healthcare experience

Tools

SQL

Microsoft Project

Smartsheet

Microsoft Office Suite

Microsoft Teams

SharePoint

Job description

Be among the first 25 applicants

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 by planning, organizing, monitoring, and overseeing programs utilizing cross-functional teams to deliver defined requirements and meet business needs and strategic objectives.

The ideal candidate 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:

1. Leverage data analysis skills to run queries, pull claims data, and identify trends, providing insights that support decision-making and issue resolution.
2. Apply working knowledge of billing and reimbursement rules, specifically for Medicare and Marketplace, to support claims analysis and ensure program compliance.
3. 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.
4. Ensure that all Medicare and Marketplace deliverables, including claim-related metrics, reference materials, and policies/procedures, meet quality and turn-around standards.
5. Drive process improvements by identifying gaps in existing procedures and collaborating with teams to implement changes that enhance efficiency and outcomes.
6. Support claims issue resolution by identifying trends, troubleshooting escalated claims concerns, and working with internal teams to ensure timely and accurate claims processing.
7. Support business department initiatives that promote quality, safety, and cost of care opportunities.
8. Gather requirements, create plans and schedules, manage resources, and facilitate project execution and deployment.
9. Utilize corporate and industry-standard tools and techniques to oversee programs according to department procedures.
10. Maintain detailed business process documentation including meeting minutes, action items, issues lists, and risk management plans.
11. Create and monitor all department deliverables to ensure adherence to quality standards, including clinical reporting documents, reference materials, and policies/procedures.
12. Communicate program status to management and key stakeholders.
13. Identify resources, resolve issues, and mitigate risks.
14. Identify requirements, procedures, and problems to improve existing processes.
15. Coordinate cross-functional meetings with various areas to meet stakeholder expectations and business objectives.
16. Manage projects through the full project lifecycle.
17. Provide leadership and communicate project status effectively to stakeholders.
18. Negotiate with project stakeholders to secure resources, resolve issues, and mitigate risks.
19. Perform other duties as assigned.
20. Comply with all policies and standards.

Education/Experience

• Bachelor's degree in a related field or equivalent experience.
• 3+ years of project management experience.
• Healthcare experience preferred.

This role requires a balance of analytical, project management, and communication skills to effectively drive Medicare and Marketplace initiatives.

Technical/Software Skills

• Data Analysis & Reporting: Proficiency in SQL or other query languages to pull and analyze claims data.
• Project Management Tools: Experience with Microsoft Project, Smartsheet, or similar tools.
• Microsoft Office Suite: Strong skills in Excel (pivot tables, VLOOKUPs, data visualization), PowerPoint, Word, and OneNote.
• Collaboration & Communication Tools: Familiarity with Microsoft Teams, SharePoint, or similar platforms.

*Applicants may work remotely anywhere in the Continental US. Preferred schedule is 8am - 5pm MST (Arizona time).

Pay Range: $68,700 - $123,700 per year.

Centene offers comprehensive benefits including health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work options. Actual pay depends on skills, experience, education, and other factors. Total compensation may include incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Applicants with arrest or conviction records will be considered per applicable laws.