Centene Corporation

Compliance

• Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates
• Monitoring proposed changes to Oregon Administrative Rules (OAR)
• Support the end-to-end process for the annual contract restatement
• Attend key meetings for Oregon Health Plan (OHP) contractor workgroups
• Support monthly Division of Financial Regulation (DFR) meetings

Regulatory Operations Analyst III – Medicaid

Pharmacist

• Act as a subject matter expert and handles more complex pharmacy issues
• Respond to escalated calls from members, provider/physician's offices and pharmacies
• Make outbound calls and enter pharmacy overrides into systems based on approved guidelines
• Take member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests
• Offer options including submission of a prior authorization request
• Thoroughly research issues and takes appropriate action to resolve them
• Assist team members often guiding them to the appropriate resolution of more complex inquiries
• Participate in training of less experienced staff
• Assist with audit preparation as needed

Senior Pharmacy Resolution Specialist

Systems Engineer

• Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications, ensuring alignment with strategic goals and solution design.
• Gathers and validates business / technology requirements to establish scope and parameters of requirements and define project impact, outcome criteria, and metrics
• Analyzes and verifies requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards
• Translates conceptual user requirements into functional requirements in a clear manner that is comprehensible to developers / project team
• Creates systems and business process models, specifications, diagrams, and charts to provide direction to developers and/or the project team
• Interprets user requirements into feasible options and communicate these back to the business stakeholders
• Manages and tracks the status of requirements throughout the project lifecycle; enforce and redefine as necessary
• Communicates changes, enhancements, and modifications of business requirements to project managers, sponsors, and other stakeholders so that issues and solutions are understood
• Plans and coordinates user acceptance testing (UAT)
• Monitors and review levels of IT services specified in the service-level agreements (SLAs) with the business
• Research, reviews, and analyzes the effectiveness and efficiency of existing requirement gathering processes and develop strategies for enhancing or further leveraging these processes; quantify potential efficiency opportunities and track accordingly
• Maintains system protocols by writing and updating procedures
• Provides references for users by writing and maintaining user documentation; provide help desk support; train users
• Prepares technical reports by collecting, analyzing, and summarizing information and trends
• Involved in clarifying requirements and implementing solutions that meet the business needs
• Documents business requirements and potential solutions for system functionality and reporting needs
• Performs other duties as assigned
• Complies with all policies and standards

Senior Business Systems Analyst

Claims Specialist

• Ensure timely processing of complex pending medical claims
• Verify and update information on the submitted claims
• Review work processes to determine reimbursement eligibility
• Process first time claims with added complexity
• Communicate with stakeholders important information needed for successful processing
• Maintain appropriate records, files, documentation, etc.
• Meet and maintain department production and quality standards
• Performs other duties as assigned

Claims Analyst II

Analyst

• Analyzes and reviews the contact center's workload to build resourcing and optimize scheduling plans to meet business objectives and goals
• Analyzes the effectiveness and complex results of the contact center's schedule and provides scheduling methodology improvements
• Participates in and leads meetings with stakeholders to analyze staffing plans and performance
• Works closely with management and other stakeholders to understand staffing requirements
• Deploys analytical techniques to create optimized schedules that balances business needs with employee preferences
• Analyzes contact center patterns, including volumes, trends, and contact center productivities
• Mentors and supports other members of the workforce scheduling team
• Advises on using a centralized vs. decentralized queue strategy and evaluates how this strategy will impact key performance metrics
• Ensures accurate records of contact center staff schedules
• Influences changes in policies and procedures for the workforce management unit

Regulatory Operations Analyst III – Medicaid

Senior Pharmacy Resolution Specialist

Senior Business Systems Analyst

Claims Analyst II

Senior Workforce Scheduling Analyst