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Senior Manager, Business & Systems Operations

Austin, Texas Apply Now Job ID 1151296 Category Health Insurance Operations Organization Centene Corporation Schedule Full-time
Description:
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.

  • 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
  • Qualifications:

    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.

    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.
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