Product Operations Specialist - Medicaid Authorizations

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: This position supports the implementation and/or drives the ongoing operational maintenance of assigned product(s) or service area(s) through communication and solid relationship management with internal and external stakeholders, identifying opportunities for integrated process improvement, escalating issues as necessary, and supporting the success of the product. Creates and maintains reporting tools to effectively analyze and develop process improvement opportunities that enhance the operational effectiveness of the product(s) or service area(s).

• Role supports Medicaid Electronic Visit Verification (EVV) portals for Providers and in the role you will be answering providers questions around authorizations, billing, claims, membership, and various portal issues.
• Serves as the subject matter expert (SME) for the assigned product(s) or service area(s).
• Drives assigned operational aspects of the product(s)/service(s).
• Assesses operational performance and escalations by tracking, analyzing and researching performance level expectations.
• Monitors assigned internal/external relationships to ensure compliance with contractual requirements.
• Develops effective relationships with key partners and stakeholders to influence and drive operational enhancements.
• Proactively identifies trends and root cause analysis to drive resolution of complex escalations; including communications and reporting.
• Creates reports and supports business review presentations to key stakeholders; including, but not limited to, Senior Leadership Team, Vendors and/or Government agencies.
• Participates in and supports department and/or product strategic planning activities.
• Manages projects including the implementations for delegated functions as needed.
• Collaborates with internal and/or external partners to execute assigned business objectives and initiatives.
• Ensures member or other stakeholder communications contain appropriate information, talking points and FAQs, and are effectively implemented.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Required A Bachelor's Degree in business administration / related field required or equivalent work experience

Candidate Experience:
Required 2+ years of experience in Leading or supporting projects in the following areas: Benefits, Product Management, Marketing and Sales, Strategic Planning, and/or Project Management.

–OR-

Data analysis and process improvement in the following areas: Benefits, Healthcare or Regulatory/Government Affairs.

-OR-

Vendor management or oversight; preferably with healthcare vendors.

Required 2+ years of experience in customer service experience in a healthcare contact center or customer service environment dealing with claims, grievances pharmacy and appeals authorizations in one or more of the following: Medicare, Medicaid, PDP, Exchange etc.
Preferred Other Experience in health care or managed care environment
Preferred Other Experience working the state reporting, regulatory/government affairs.

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. Total compensation may also include additional forms of incentives.

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