Payment Integrity Specialist - Governance

Centene Corporation•St. David's, MO

1d•Hybrid

About The Position

The Senior Business Process Consultant leads business case development for proposed initiatives, supports the strategic planning process, and leads larger scale, cross-functional initiatives. Leads business case development for proposed initiatives to ensure adequate assessment of opportunities, risks and return on investment. Provides input and supports planning and prioritization of initiatives as part of the strategic and business planning process. Ensures that initiatives support the strategic business plan, meet key business objectives and are executed well tactically. Ensures that all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative). Leads larger scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance. Provides strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results. Organizes work teams, drives consensus and ensures end to end policy/process integrity to accomplish project work: including identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight. Performs detailed analysis of data, workflows, policies, procedures, organization of staff, and skills in order to execute initiatives. Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project. Leads all levels of staff who are responsible for initiatives included in the companies operating plan in order to support their success, development and effective completion and communication of their initiative. Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc. Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives. Provides other related support as needed to improve the performance of the business Performs other duties as assigned. Complies with all policies and standards.

Requirements

Bachelor's Degree in a related field or equivalent experience required
6+ years managing projects required
Certified Project Management Professional (PMP)-PMI required

Nice To Haves

Master's Degree in a related field preferred
Experience in health care and/or insurance preferred
Process quality certification preferred

Responsibilities

Leads business case development for proposed initiatives to ensure adequate assessment of opportunities, risks and return on investment.
Provides input and supports planning and prioritization of initiatives as part of the strategic and business planning process.
Ensures that initiatives support the strategic business plan, meet key business objectives and are executed well tactically.
Ensures that all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative).
Leads larger scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance.
Provides strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results.
Organizes work teams, drives consensus and ensures end to end policy/process integrity to accomplish project work: including identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight.
Performs detailed analysis of data, workflows, policies, procedures, organization of staff, and skills in order to execute initiatives.
Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project.
Leads all levels of staff who are responsible for initiatives included in the companies operating plan in order to support their success, development and effective completion and communication of their initiative.
Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc.
Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives.
Provides other related support as needed to improve the performance of the business
Performs other duties as assigned.
Complies with all policies and standards.