Job 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.

Fully Remote role

Position Purpose: Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons.

• Analyze trends in claims processing issues and identify work process solutions

• Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track

• Assist in the writing work processes and continual auditing of the processes to ensure configuration, state mandates, benefits, etc

• Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system

• 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

• Travel and in-person provider interaction required

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: High school diploma or equivalent. 5+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Knowledge of provider contracts and reimbursement interpretation preferred.

License/Certification: CPC certification preferred.

Claims Administration / Corporate: Customer service, data entry, data analysis for trending and tracking, and/or root cause analysis. The ability to disseminate information across a wide variety of audiences. The ability to prioritize work and successfully handle issue resolution in a timely manner.

Pay Range: $22.79 - $38.84 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, 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

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