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.
**Remote CA**
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
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. Familiarity with the Claims Operations Users Manual, Appeals/PDR experience, Extensive claims research, Adjustment training, Extensive Amisys or ABS experience preferred. Pay Range: $21.93 – $37.30 per hour
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.