Position Purpose: Identify, manage and oversee the system and business requirements for new and existing business and ensure performance meets all health plan, state, and provider contract requirements.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

This is a remote role that can be based anywhere within the continental US.

• Oversee the successful setup of system builds for new markets and products system, including configuration and testing
• Monitor and evaluate trends in system performance and identify new opportunities or improvements
• Oversee and ensure timeliness and accuracy of all reporting deliverables
• Establish and manage business specifications for authorization and claims/encounters system infrastructure in alignment with all relevant requirements to maintain system specifications
• Identify and implement process improvements for various functions, including new business implementations, claims, encounters performance and auto adjudication, extensive testing benefit specifications, and system integrity
• Establish and manage special projects to improve processes to increase efficiency, productivity, and accuracy across the organization
• Oversee the design and maintenance of all market provider contract rate exhibits and configuration and testing of negotiated contracts

Education/Experience: Bachelor’s degree in related field or equivalent experience. Master’s degree preferred. 6+ years of health care operations, system administration, product/program management or claims administration experience. Experience with Medicaid and Medicare coding, benefit design and various reimbursement strategies/methodologies. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Contracting and provider data management experience preferred.

Pay Range: $107,700.00 - $199,300.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act