• Job Description

  Req#: 1480491

  You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
  

  100% Remote

  Central Time Zones: Mon - Fri: 10:00 AM – 7:00 PM or 11:00 AM – 8:00 PM
  Must have reliable Internet service (i.e. no Wi-Fi or mobile hot spots)

  Position Purpose: Generates, processes and maintains provider and member correspondence for preservice and concurrent review.

  • Generates correspondence from EMR documentation and ensures correspondence tasks are processed in a timely manner to ensure compliance according to regulatory standards and policies

  • Updates and maintains correspondence templates based on regulatory, and interdepartmental correspondence inquiries

  • Coordinates all data collection, analysis, and reporting activities that impact the denial process

  • Assists with the compliance and turn-around time (TAT) log for all correspondence notifications

  • Performs other duties as assigned

  • Complies with all policies and standards

  Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of denials process including understanding medical record information preferred.

  Preferred Qualifications:

  • 5+ years of work experience in healthcare operations and/or managed care environments - Medicaid, Medicare and Marketplace insurance preferred.

  • Experience processing high volumes of insurance denials, appeals, and/or medical claims for multiple lines of business and multiple states (i.e. 20+ states) is strongly preferred.

  • Must be highly adaptable and flexible with business needs, workflow changes, and skilled at learning new processes

  • Role requires deductive reasoning, problem solving, and high level of accuracy and attention to detail is essential in this role (i.e. ensure compliancy with NCQA standards)

  • Experience meeting daily work deadlines and turn-around-times (TAT) in accordance with MCO guidelines

  • Strong administrative, multi-tasking, organization, and time management skills

  • Excellent verbal and written communication skills with multiple stakeholders

  • Excellent customer service and conflict resolution skills

  • Proficient computer skills and experience working within large provider information systems and Microsoft Office applications (i.e., Amisys, CMS, Omni, TruCare, ZOOM, MS Teams, MS One Note, and Microsoft Office Suite).

  • Proficiency in utilizing multiple avenues of communication (e.g. instant messaging, email, phone, video conferencing) is 90% of the role responsibilities.

  • Proficiency in basic Internet skills (e.g. navigate using a browser, locate web addresses, create hyperlinks, use bookmark/favorites, understand simple search concepts/functions)

  • Ability to work independently

  
  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.

• About the company

  Centene Corporation is a publicly traded managed care company based in St.

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