Payment Integrity Business Partner II

🔥 0 minutes ago

🐊 Florida, Illinois, +3 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $63.6k - $114.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🪙 Affiliate 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

• 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 • Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives • Communicate program performance, savings opportunities, operational impacts, trends, and policy updates • Support implementation of Payment Integrity initiatives across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams • Manage assigned vendor relationships and monitor performance • Support revenue-enhancement and operational improvement initiatives • Facilitate resolution of stakeholder, provider, regulatory, vendor, and operational issues • Analyze performance metrics and identify opportunities to improve payment accuracy, operational effectiveness, and stakeholder experience • Document decisions, themes, risks, and follow-up actions • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's degree and 2–4 years of related experience, or equivalent experience acquired through applicable knowledge, duties, scope and skill • 3+ years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related field • Experience collaborating with and influencing cross-functional teams and business stakeholders • Experience presenting information, updates, and recommendations to leadership or business partners • 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 • 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 plan • 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