Health Net, Inc. Hiring For Manager, Process Operations at District 12, MD Full Time

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Identify and implement process improvements for various functions, including new business implementation, claims and encounters performance, benefit specifications, and system integrity.Identify and manage the system and business requirements for new and existing business and ensure that performance meets all health plan, state, and provider contract requirements
Research, define, and manage business specifications for creating system infrastructures for new market builds and identify and maintain specifications to accommodate changes for existing markets based on regulatory or business changes.
Monitor system performance and accuracy, ensuring metrics for provider load, claims processing, encounter submission, and other similar functions are met
Identify systematic solutions for internal and external stakeholders regarding requirements or business needs and ensure solutions are put into production
Initiate and manage special projects to improve processes to increase efficiency, productivity, and accuracy across the organization
Design provider contract rate exhibits and implement negotiated contracts
Create, maintain and approve reports for contractual obligations and monitor performance
Create and maintain additional reference documentation regarding market specific setup and operational processes, including policies and procedures
Role will lead an operations team of Business Analysts who support pricing and benefits configuration for Medicaid Behavioral Health services.
Team responsibilities include documenting business requirements, inventory management, ensuring quality claim outcomes, and having a high degree of collaboration with health plan partners/key stakeholders.Education/Experience: Bachelor’s degree in related field or equivalent experience. Master’s degree preferred. 5+ years of health care operations, system administration, product/program management, or claims administration experience. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Contract negotiation or management experience preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.