Senior Manager, Payment Integrity - Vended Audit Programs

Centene Corporation • Remote-MO, MO

5d • $107,700 - $199,300

About The Position

The Senior Manager, Payment Integrity - Vended Audit Programs oversees and monitors internal and external cost recovery and cost containment initiatives. The role is responsible for measuring performance against project metrics and forecasted recovery and cost avoidance goals for each Health Plan, and for managing vendors’ cost avoidance and cost recovery initiatives.

The position partners with health plans and national vendors to identify and contain costs, develops annual budgets and projected targets for national vendors, and supports vendors in achieving projected savings. It evaluates and streamlines existing processes, implements new cost-reduction processes, presents trends and opportunities, recommends and helps implement action plans, and helps health plans understand cost recovery rules, regulations, and processes. The role also monitors other departments’ performance and processes for potential cost recovery, prepares reporting packages for Senior Management, performs other duties as assigned, and complies with all policies and standards.

Requirements

• Bachelor’s degree in Accounting, Finance, Healthcare Management, a related field, or equivalent experience.
• At least 6 years of data analysis, finance, or accounting experience.

Nice To Haves

• Experience with government programs auditing and compliance monitoring programs.
• Project management experience.

Responsibilities

• Oversee and monitor internal and external cost recovery and cost containment initiatives against 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 costs through collaboration with national vendors for each recovery category.
• Develop annual budgets and projected targets for each national vendor and assist vendors in 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 their implementation.
• Assist health plans in understanding rules, regulations, and processes related to cost recovery.
• Monitor other departments’ performance and processes and evaluate them for cost recovery opportunities.
• Compile and present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay.
• Health insurance.
• 401K and 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, subject to applicable factors and eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager