Payment Integrity Business Partner II

Centene Corporation•St. David's, MO

About The Position

The Payment Integrity Business Partner serves as a primary liaison between Payment Integrity and assigned health plans, lines of business, providers, vendors, and internal stakeholders. The role provides consultative support, facilitates issue resolution, communicates program performance and savings opportunities, and helps align Payment Integrity initiatives with business objectives. It supports collaboration across Medicaid, Medicare, Marketplace, and other lines of business, advancing payment accuracy, operational effectiveness, vendor performance, and stakeholder engagement. The position manages complex situations and projects, solves problems, and influences stakeholders through clear explanations of facts, policies, and practices. The role serves as the primary contact for assigned health plans, markets, and stakeholders regarding Payment Integrity programs, initiatives, and issue resolution. It builds working relationships, represents Payment Integrity in meetings and strategic forums, communicates performance and policy information, coordinates initiative implementation across teams, and manages assigned vendor relationships. It also facilitates issue resolution, analyzes performance metrics, identifies improvement opportunities, and documents decisions, risks, and follow-up actions. A bachelor's degree and 2–4 years of related experience are required, or equivalent experience acquired through relevant knowledge, duties, scope, and skills. The posting also requires 3+ years of experience in a related healthcare field, experience influencing cross-functional teams, and experience presenting information and recommendations. Relevant domain, vendor-management, provider/regulatory/compliance, and data-interpretation experience is preferred. PMP and/or Lean Six Sigma certification, along with related project or process-improvement experience, is strongly preferred. Applicants must be authorized to work in the United States without current or future employment-based visa sponsorship. Centene describes its work as supporting access to healthcare and improving lives, and offers a comprehensive benefits package. Work schedules may be remote, hybrid, field, or office; the specific arrangement for this position is not stated.

Requirements

Bachelor's degree and 2–4 years of related experience, or equivalent experience acquired through applicable knowledge, duties, scope, and skills.
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.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Nice To Haves

Experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations.
Experience managing vendors, outsourced services, or external business partners.
Experience supporting provider, regulatory, compliance, audit, or revenue-enhancement activities.
Experience interpreting operational, financial, or performance data.
Certified Project Management Professional (PMP)-PMI and/or Lean Six Sigma certification, with related project, process-improvement, or operational-excellence experience.

Responsibilities

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 to support timely communication and alignment.
Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives related to assigned markets or programs.
Communicate program performance, savings opportunities, operational impacts, trends, and policy updates to stakeholders clearly and actionably.
Support implementation of Payment Integrity initiatives and coordinate activities across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams.
Manage assigned vendor relationships, monitor performance, and support revenue-enhancement and operational improvement initiatives within assigned scope.
Facilitate resolution of stakeholder, provider, regulatory, vendor, and operational issues, ensuring timely communication, follow-through, and appropriate escalation.
Analyze performance metrics and identify opportunities to improve payment accuracy, operational effectiveness, and stakeholder experience.
Document decisions, themes, risks, and follow-up actions to support consistent execution and visibility across Payment Integrity partners.
Perform other duties as assigned.
Comply with all policies and standards.