Program Manager III - Recovery Operations/Payment Integrity

Position Purpose: This position is responsible for leading recoupment claim inventory management and BOT automation monitoring to ensure Payment Integrity Amisys, Facets, Xcelys, and ABS recovery processes operate as expected, resolving issues timely. The role also reviews savings BOT automation issues to identify and address potential concerns. In addition, the position collaborates closely with recoupment program SMEs, IT, and Claims teams to resolve inventory and BOT automation issues.

Key Details: This is a fully remote role, applicants can work anywhere in the continental United States.

• Identify opportunities to increase efficiency, improve service levels and to ensure regulatory compliance through enhanced operations.
• Develop strategies to realize improvement opportunities, and ensure organizational prioritization and resource alignment.
• Manage multiple projects through full project life cycle process including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure.
• Utilize corporate and industry standard project management tools and techniques to effectively manage projects.
• Maintain detailed project documentation as needed including action items, issues lists and risk mitigation plans.
• Provide leadership and effectively communicate project status to all stakeholders, including executive summaries and presentations.
• Negotiate with project stakeholders to identify and secure resources, resolve issues, and mitigate risks.
• Lead cross-functional meetings with various functional areas to meet overall stakeholder expectations and company’s objectives.
• Provide functional and technical knowledge regarding overall program requirements and operations.

Education/Experience:

• Bachelor’s degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master’s degree preferred. 5+ years project implementation, product or program management experience. Managed care or prescription benefit management experience preferred.
• Preferred experience driving initiatives within healthcare recovery operations, payment integrity, claims operations, revenue cycle, or related healthcare business functions.

Pay Range: $87,700.00 - $157,800.00 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

Originally posted on Himalayas