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Position Purpose: The Payment Integrity Business Partner serves as a primary liaison between Payment Integrity and assigned health plans, lines of business, providers, vendors, and internal stakeholders. The role provides consultative support, facilitates issue resolution, communicates program performance and savings opportunities, and helps ensure alignment between Payment Integrity initiatives and business objectives. This position supports cross-functional collaboration across Medicaid, Medicare, Marketplace, and other lines of business, while helping advance payment accuracy, operational effectiveness, vendor performance, and stakeholder engagement. The role manages through difficult situations and projects, effectively solves problems, and influences stakeholders through clear explanation of facts, policies, and practices.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Serve as the primary point of contact for assigned health plans, markets, and stakeholders regarding Payment Integrity programs, initiatives, 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 related to assigned markets or programs.
Communicate program performance, savings opportunities, operational impacts, trends, and policy updates to stakeholders in a clear and actionable manner.
Support implementation of Payment Integrity initiatives and coordinate activities across operational, clinical, coding, analytics, compliance, regulatory, and vendor teams.
Manage assigned vendor relationships, monitor performance, and support revenue-enhancement and operational improvement initiatives within assigned scope.
Facilitate resolution of stakeholder, provider, regulatory, vendor, and operational issues, ensuring timely communication, follow-through, and appropriate escalation.
Analyze performance metrics and identify opportunities to improve payment accuracy, operational effectiveness, and stakeholder experience.
Document decisions, themes, risks, and follow-up actions to support consistent execution and visibility across Payment Integrity partners.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience:
Requires a Bachelor's degree and 2 – 4 years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
3+ years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related field required.
Experience collaborating with and influencing cross-functional teams and business stakeholders required.
Experience presenting information, updates, and recommendations to leadership or business partners required.
Experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations preferred.
Experience managing vendors, outsourced services, or external business partners preferred.
Experience supporting provider, regulatory, compliance, audit, or revenue-enhancement activities preferred.
Experience interpreting operational, financial, or performance data preferred.
License/Certification:
Certified Project Management Professional (PMP)-PMI and/or Lean Six Sigma certification and related project, process improvement, or operational excellence experience strongly preferred preferred
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act