Payment Integrity Business Partner II

Centene
Missouri, North Carolina, Texas, Illinois, Florida
Workplace: RemoteFull timeUSD 63,600 - 114,600 annuallyFunction: Business OperationsExperience: 2-4 yearsEducation: bachelorsSkills: ["Stakeholder management","Communication","Problem-solving","Cross-functional collaboration","Data analysis"]

Serve as the primary liaison between Payment Integrity and assigned health plans, lines of business, providers, vendors, and internal stakeholders. Support issue resolution and alignment across Medicaid, Medicare, Marketplace, and other programs by communicating performance, savings opportunities, and policy updates. Coordinate cross-functional implementation with operational, clinical, coding, analytics, compliance, and vendor teams while monitoring vendor performance, analyzing payment accuracy metrics, and documenting decisions and risks.

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FursaFursa
Centene
Centene
4 days ago

Payment Integrity Business Partner II

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Last checked: 3 days agoStatus: Live

Job Summary

Serve as the primary liaison between Payment Integrity and assigned health plans, lines of business, providers, vendors, and internal stakeholders. Support issue resolution and alignment across Medicaid, Medicare, Marketplace, and other programs by communicating performance, savings opportunities, and policy updates. Coordinate cross-functional implementation with operational, clinical, coding, analytics, compliance, and vendor teams while monitoring vendor performance, analyzing payment accuracy metrics, and documenting decisions and risks.
Location: Missouri, North Carolina, Texas, Illinois, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Business Operations
Seniority: Mid level

Key Responsibilities

  • •Serve as the primary point of contact for assigned health plans, markets, and stakeholders regarding Payment Integrity programs and issue resolution.
  • •Build and maintain working relationships with market leadership, providers, vendors, and internal business partners to support timely communication and alignment.
  • •Represent Payment Integrity in meetings, workgroups, governance forums, and strategic initiatives for assigned markets or programs.
  • •Communicate program performance, savings opportunities, operational impacts, trends, and policy updates to stakeholders in a clear and actionable manner.
  • •Analyze performance metrics, monitor vendor performance, facilitate resolution of stakeholder/provider/regulatory/vendor/operational issues, and document decisions, themes, risks, and follow-up actions.

Pay and Benefits

Salary: USD 63,600 - 114,600 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s degree and 2–4 years of related experience.
  • •3+ years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related field.
  • •Experience collaborating with and influencing cross-functional teams and business stakeholders.
  • •Experience presenting information, updates, and recommendations to leadership or business partners.
  • •Experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations, or related preferred knowledge.
  • •Certified Project Management Professional (PMP)-PMI and/or Lean Six Sigma certification strongly preferred.
Experience:2-4 yearsHealthcareManaged careClaimsPayment integrity
Education:Bachelor's
Skills:Stakeholder managementCommunicationProblem-solvingCross-functional collaborationData analysis
Certifications:PMPLean Six Sigma

Eligibility

Visa:H-1BL-1O-1H-1B1F-1J-1OPTCPT
Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn