Senior Manager, Payment Integrity - Data Mining Programs

Centene Management Company LLC; Missouri; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plans

Tuition reimbursement

PTO + holidays

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a senior role focused on cost recovery and cost containment across health plans. The role entails overseeing internal and external initiatives, working with national vendors, and driving savings through rigorous budgeting and process improvements.

You'll present trends, guide action plans, and ensure compliance with relevant rules and standards while collaborating with multiple plans and departments to optimize overall cost efficiency.

Qualifications

• Experience in data analysis, finance or accounting.
• Familiarity with government programs auditing and compliance monitoring.
• Project management experience preferred.

Responsibilities

• Oversee and monitor cost recovery and cost containment initiatives against metrics and forecasts.
• Manage internal and external vendors’ cost avoidance and cost recovery initiatives.
• Partner with health plans to contain costs via national vendors for each recovery category.
• Develop annual budgets and targets for national vendors and aid in achieving savings.
• Evaluate and streamline processes to reduce costs and implement new ones.
• Present trends and opportunities, recommend action plans, and support implementation.
• Assist health plans in understanding rules and processes around cost recovery.
• Monitor other departments’ performance for cost recovery potential.
• Prepare reporting packages for Senior Management on cost avoidance/recovery initiatives.
• Perform other duties as assigned and comply with policies.

Skills

Data analysis

Finance

Accounting

Project management

Auditing government programs

Compliance monitoring

Education

Bachelor’s degree in Accounting, Finance, Healthcare Management, related field or equivalent experience

Job description

Position Purpose

• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education and Experience

• 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.

Pay Range: $107,700.00 - $199,300.00 per year

Benefits

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

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.

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.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.