Senior Manager, Payment Integrity - Data Mining Programs

Centene Corporation; Town of Florida (NY); Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a senior role to oversee and monitor cost recovery and cost containment initiatives across health plans. You will manage vendor efforts, partner with plans to identify savings, and develop annual budgets to drive cost avoidance.

The position emphasizes process improvement, reporting to Senior Management, and ensuring compliance with applicable rules and regulations while offering a flexible work approach.

Qualifications

• Bachelor’s degree in Accounting, Finance, Healthcare Management, related field or equivalent experience.
• 6+ years of data analysis, finance or accounting experience.
• Project management experience preferred.

Responsibilities

• Oversee and monitor cost recovery and cost containment initiatives for Health Plans.
• Manage internal and external vendors cost avoidance and cost recovery initiatives.
• Partner with health plans to identify and contain costs through collaboration with national vendors.
• Develop annual budgets and targets for national vendors and assist in achieving savings.
• Evaluate and streamline processes to reduce costs and improve efficiency.
• Present trends and cost containment opportunities and assist with action plans.
• Assist health plans in understanding rules, regulations and processes around cost recovery.
• Monitor other departments’ performance and evaluate for cost recovery.
• Compile and present reporting packages for Senior Management on cost avoidance and recovery initiatives.

Skills

Data analysis

Finance

Accounting

Project management

Education

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

Job description

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

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/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

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and 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