Centene Corporation

Financial Planning and Analysis

• Price Transparency reviews and comparisons to existing contracts and rates
• Review rates in expansion regions or states
• Work closely with Network Development and Strategy as well as Reimbursement teams
• Create and analyze monthly, quarterly, and annual reports and ensures financial information has been recorded accurately
• Identify trends and developments in competitive environments and presents findings to senior management
• Perform financial forecasting and reconciliation of internal accounts
• Performs other duties as assigned
• Complies with all policies and standards

Finance Analyst II – Network Reimbursement

Compliance

• Manage the compliance department functions
• Conduct periodic assessments to ensure compliance against contract requirements
• Oversee creation and implementation of corrective action plans
• Manage and oversee the composition and delivery of responses to regulatory agency complaints and inquiries
• Design, implement and improve processes to prevent, detect and respond to compliance issues
• Create and deliver compliance training for all employees

Compliance Manager

Research Analyst

• Act as a liaison between provider relations, provider services, health plan, and corporate for claims inquiries
• Respond to internal and external claims related issues
• Initiate entry or change of provider related database information
• Complete claims related research projects
• Assist with data integrity of provider claims processing system
• Investigate and communicate reimbursement and benefit changes
• Educate provider relations and services regarding policies and procedures
• Assist providers with claims submission and payment accuracy

Claims Research Specialist

Business Analyst

• Perform various analysis and interpretation to link business needs and objectives for assigned function
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Develop and incorporate organizational best practices into business applications
• Lead problem solving and coordination efforts between various business units
• Assist with formulating and updating departmental policies and procedures

Business Analyst II, Claims Systems

Project Manager

• Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives
• Manage the full project life cycle 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
• Assist with establishment and maintenance of corporate project management methodology and other department procedures
• Maintain detailed project documentation including meeting minutes, action items, issues lists, and risk management plans
• Effectively communicate project status to all stakeholders
• Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives
• Provide functional and technical knowledge across multiple business and technical areas
• Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation
• Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics

Project Manager II – External Audit

Analyst

• Provides analytic support for financial modeling, trend analysis, therapeutic class strategy, and initiative implementation and measurement
• Develops custom reports and models used in identifying issues, trends, patterns and relationships to be applied in financial and operational decisions
• Develops financial models to project cost or estimate savings for specific business decisions
• Develops and manages therapeutic class cost and utilization projection models to support budget forecasting, pricing, and strategy development
• Develops exception reporting and conducts drill down analysis to proactively identify specific opportunities and risks
• Monitors projection targets
• Analyzes, researches, and interprets results, variances, and trends
• Prepares and maintains strategy documents for therapeutic classes
• Prepares and communicates trend analysis and recommendations verbally and in writing to committees, clinical staff, management, and clients
• Develops and manages reporting templates used to analyze and interpret data
• Designs complex ad hoc reports to support a variety of functional areas
• Advises Healthcare Analysts in producing reports and interpreting data

Senior Health Care Analyst

Business Intelligence Developer

• Creates reports, visualizations, dashboards, and metrics that provide business insight and aid business decision-making
• Produces reports and performs meaningful quantitative or qualitative analyses addressing impactful business issues or questions
• Combines these reports with subject-matter expertise to deliver coherent, insightful takeaways, and advice
• Develops BI solution architecture that accurately translates business requirements to technology
• Supports day-to-day activities related to defining architecture, establishing infrastructure, and implementing standards
• Conducts business analysis activities to enable technology solutions that fulfill strategic business needs
• Supports the execution of long-term strategic goals for Business Intelligence development
• Conducts research and makes recommendations on Business Intelligence products, services, and standards
• Performs and oversees programming, quality assurance reviews, documentation, system deployment, training, and project setup/support
• Provides timely and appropriate communication to business owners, stakeholders, and users on issue status and resolution
• Develops and maintains the Business Intelligence architecture

Business Intelligence Engineer I

Account Executive

• Prospect and establish new account relationships with physicians’ office, nursing agencies, hospitals, and community based organizations over the telephone
• Perform outreach to potential clients regarding business unit services and programs, such as referral processing
• Distribute sales leads to Physician Sales, log and follow-up on distributed leads
• Identify and develop marketing strategy for key accounts
• Monitor all referrals as they traverse through operational stages through final delivery to the patient
• Develop and maintain relationships with clients ensuring alignment with marketing strategies
• Prepare and complete proper administrative records and sales reports
• Analyze prescriber data to target potential accounts
• Determine customer needs and communicate needs to operations while managing the operational relationships to fully service the client
• Attend routine patient care conferences and professional in-services to ensure continuance of new products and strategies

Inside Sales Representative II

Marketing

• Assist in the planning, implementation and evaluation of the state-wide marketing & communication program while promoting a favorable public image of the company and each of its product lines
• Develop, coordinate and promote various new programs and initiatives
• Assist, review, and provide feedback to subsidiaries on larger campaigns and initiatives
• Educate and train subsidiaries marketing and communication counterparts on new processes
• Assist in the design, review and revision of all health-related materials distributed to members while ensuring appropriateness of content, readability and translations
• Order and track promotional items for all products and all service areas while ensuring budget compliance and reporting financial impact
• Ensure the completion of monthly outreach calendars by regional outreach staff for all service areas
• Serve as a contact for community agencies, businesses, fundraisers, community events etc.
• Research data, construct ideas, lay out artwork, and/or represent employer directly before the public
• Prepare news releases, fact sheets and compose letters as needed
• Performs other duties as assigned
• Complies with all policies and standards

Senior Marketing and Communication Specialist

• Responsible for the management and oversight of the data privacy compliance program to ensure compliance with applicable policies and regulations across the organization.
• Represent the Privacy department in Enterprise level programs and initiatives.
• Develop and maintain relationships with cross functional teams to promote a culture of privacy and compliance.
• Implement standards and processes to ensure compliance with new and changing privacy regulations.
• Manage, monitor and report on Enterprise Privacy vendors’ performance.
• Monitor and audit privacy compliance program processes and documentation to ensure compliance with company policy and regulatory requirements.
• Coordinate with other functional areas to address data privacy compliance issues and concerns that impact the business.
• Coordinate investigations into data privacy and security incidents.
• Develop, implement and manage corrective actions to remediate incidents of data privacy non-compliance.
• Develop and maintain reporting metrics of data privacy department activities.
• Conduct training on data privacy requirements and policies.
• Mentor team members to improve knowledge and skillset related to data privacy program processes and requirements.

Senior Manager, Privacy Compliance

Vice President

• Responsible for the growth and performance of assigned mid/high complexity and revenue Medicare markets.
• Develop and execute market-specific strategies.
• Drive operational excellence and manage P&L of assigned markets.
• Foster cross-functional collaboration and build strong partnerships.
• Monitor market landscape to recommend strategies for changing needs.

Vice President, Medicare Market

Product Analyst

• Support the product team's focus on offering quality, competitive product solutions for growth and retention of members
• Provide tactical, operational, execution and analytical support for assigned Ambetter and Medicare product portfolio
• Responsible for delivering compliant products to market while supporting business goals and objectives
• Perform product-related operational tasks by assisting with new product development and product feature updates, providing data, assembling reports, and regulatory filings
• Develop trust-based relationships and collaborates with other functional areas to collect information
• Conduct basic qualitative and quantitative analysis on Ambetter or Medicare product performance, market share, and general competitor information
• Research competitor products, perform regulatory compliance analysis, and disseminate information with recommendations

Commercial Product Analyst

• Responsible for leading and managing the most complex, sensitive, and high-impact internal investigations across the organization
• Serves as a strategic advisor and subject matter expert on investigative best practices, regulatory compliance, and risk mitigation
• Independently evaluates and assesses allegations to determine whether domestic laws, regulatory policies, or internal policies, procedures, and standards have been violated
• Plans, scopes, and conducts complex, confidential internal investigations from inception to conclusion
• Conducts, manages, and documents interviews with witnesses, as required for investigatory purposes
• Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks
• Performs follow up to ensure remedial / disciplinary measures are implemented appropriately and timely
• Prepares clear and concise draft investigation plans and reports

Principal Compliance Investigator

Procurement

• Lead the standardization and continuous improvement of vendor management practices across Enterprise Operations and Clinical Services.
• Provide strategic oversight and influence across multiple vendor management teams, ensuring operational excellence and compliance.
• Partner with leadership to drive initiatives that support broader enterprise goals.
• Document vendor management process from intake/evaluation through termination/renewal.
• Work with vendor managers to identify risks & opportunities and document workplan.
• Create a roadmap of Vendor Management standards and process improvements to be implemented; execute based on prioritization.
• Own and maintain comprehensive playbook for entire VM lifecycle.
• Develop and maintain infrastructure and tools for ECOS vendor management.
• Coordinate vendor management for vendors with fragmented management, including cross-functional vendors.
• Support vendor managers as needed.

Senior Manager, Vendor Management

• Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
• Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
• Participate in the development of network management strategies
• Creates strategic initiatives for performance improvement
• Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components
• Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc
• Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level
• Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance
• Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
• Receive and effectively respond to external provider related issues
• Investigate, resolve and communicate provider high dollar and high volume provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Evaluates provider performance and develops strategic plan to improve performance
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Acts as a lead for the external representatives
• Coaches and trains external representatives
• Ability to travel locally 4 days a week
• Performs other duties as assigned
• Complies with all policies and standards