Company

Centene Corporation

Description

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 Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

Audit check run and send claims to the claims department for corrections
Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
Collaborate with the claims department to price pended claims correctly
Document, track and resolve all plan providers’ claims projects
Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
Identify authorization issues and trends and research for potential configuration related work process changes
Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
Identify potential and documented eligibility issues and notify applicable departments to resolve
Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
Run claims reports regularly through provider information systems
Research verbal and written providers’ claims inquiries as needed

For PA H&W only

Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.

Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources

Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

Education/Experience High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation 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.

Identifier

039cc185a2c3e79d39acba415bed6aca