• Job Description

  Req#: 1501377

  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: With the Risk Adjustment Corporate team, you will identify, analyze, and resolve provider claims and encounter submission issues with the Medicaid In Home Assessment program.

  • Review of Medicaid In Home Assessment provider claims and work with the corresponding outbound encounters team and/or health plans for resolution of denied claims.
  • Ensure Configuration is in place for all participating provider agreements within Risk Adjustment.
  • Ensure all ICD 10 and CPT codes as configured as necessary.
  • Track claim resolutions and denial reasons.
  • Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing
  • Establish and monitor prioritization process to reduce backlog of encounters projects
  • Assist with reviews and initiate discussion with providers as needed on encounter scrubs and pends
  • Lead claim projects, pricing issues and documenting trends for contract implementation on system issues and provider education

  Education/Experience: Associate’s degree in Business Administration, Health Care Administration, related field, or equivalent experience. 4+ years of combined claims processing and data analysis or related insurance experience. Lead or supervisory experience preferred.

  Preferred Skills:

  Ability to research and provide appropriate solutions for remediation and reconciliation

  Database management

  Familiarity with claims denial reasons and solutions to correct

  Pay Range: $54,000.00 - $97,100.00 per year

  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.

• About the company

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

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