Senior Manager, Payment Integrity

🕒 2 days ago

🐊 Florida, Missouri, +1 more states – Remote

🐊 Florida – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Provide strategic and operational leadership across the Health Plan Concierge vertical and Payment Integrity activities within an assigned line of business • Oversee market engagement, provider alignment, escalation management, and cross-functional coordination • Lead teams addressing provider and market needs and resolve complex provider issues • Direct forums and taskforces that translate experience signals into Payment Integrity priorities • Execute strategies to reduce improper payments, enhance claims accuracy, and support financial and operational objectives • Implement governance processes, controls, documentation standards, and performance measures • Collaborate with Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, IT, and Health Plan teams • Lead insight-generation and analytics activities to identify provider pain points, operational risks, trends, and improvement opportunities • Direct provider education and communication efforts related to Payment Integrity edits, audits, policies, and process changes • Coordinate documentation, clarify program requirements, and ensure timely and accurate case management for escalated provider issues • Ensure compliance with CMS, Medicaid, Medicare, state regulatory requirements, coding and documentation standards, and applicable policies • Present program performance, provider issue themes, savings outcomes, and risk mitigation strategies to inform governance and planning • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or related field, or equivalent work experience required • 6+ years of experience in Payment Integrity, claims operations, reimbursement methodologies, or managed care operations within a complex health plan or multi-line payer • 4+ years of leadership experience with direct reports • 3+ years of experience with Payment Integrity functions such as pre-pay edits, post-pay audits, analytics, or fraud, waste, and abuse programs • 2+ years of managing escalated issues with senior leaders • Cross-functional experience with Network, Claims, Clinical, Legal, Compliance, IT, Finance, and Health Plan leadership • Experience leading provider-facing communications, education, disputes, or external stakeholder engagement • Strong understanding of payment integrity concepts, reimbursement methodologies, provider workflows, and applicable regulatory requirements • Ability to use analytics and insights to identify trends, diagnose root causes, and drive operational improvement • Strong communication and relationship management skills; ability to translate complex Payment Integrity programs into clear guidance • Ability to influence across a matrixed environment and communicate risk, compliance considerations, and operational impacts to leadership • Experience with Medicaid and/or Medicare managed care requirements and regulatory expectations preferred

🏖️ Benefits

• competitive pay • health insurance • 401K • stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules • additional forms of incentives may be included in total compensation