Claims Research Specialist
About The Position
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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Perform duties to act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries. Receive and respond to internal and external claims related issues. Initiate entry or change of provider related database information. Complete claims related research projects. Assist with responsibilities related to data integrity of provider claims processing system. Investigate and communicate reimbursement and benefit changes. Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission. Assist providers with resolving issues with claims submission and payment accuracy. Attend state meetings with regards to fee schedule and benefit changes. Assist with provider complaints & resolutions regarding claims issues and process claims adjustments. Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.
Requirements
- High school diploma or equivalent.
- 3+ years of experience in claims payment processing in government programs and experience in a managed care environment.
- Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.
Nice To Haves
- Bachelor’s degree preferred.
Responsibilities
- Act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries.
- Receive and respond to internal and external claims related issues.
- Initiate entry or change of provider related database information.
- Complete claims related research projects.
- Assist with responsibilities related to data integrity of provider claims processing system.
- Investigate and communicate reimbursement and benefit changes.
- Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission.
- Assist providers with resolving issues with claims submission and payment accuracy.
- Attend state meetings with regards to fee schedule and benefit changes.
- Assist with provider complaints & resolutions regarding claims issues and process claims adjustments.
- Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.
Benefits
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
