Senior Manager, Business & Systems Operations
Posted on: 7 Feb 2021
Clayton, MO
Job 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
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 working with Amazon Web Services (AWS). 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.
title:Senior Manager, Business & Systems Operations
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
