Provider Reimbursement Auditor

Centene Corporation • Remote-FL, MO

4d • $23 - $40 • Hybrid

About The Position

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. This position performs comprehensive audits of provider claims to source documents and identify mis-payments.

Requirements

• Associate’s degree in related field or equivalent experience.
• 2+ years of medical or pharmacy claims processing or claims pricing experience.
• Medicaid and Medicare reimbursement rules
• Ability to interpret state and provider contracts
• Knowledge of CPT/HCPCS Coding

Nice To Haves

• Strong Excel Skills
• Excel Calculator
• Provider Contractors
• Claims Analyst
• Provider Claims
• Experience working remote

Responsibilities

• Conduct quality audits of provider claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
• Analyze errors and determine root causes for appropriate error responder assignment.
• Utilize audit software to provide written documentation regarding audit observations
• Analyze and review responses to audit observations to validate accuracy.
• Provide updates to audit criteria including maintaining state ACME, reviewing state website for updates, documenting business decisions, identifying required updates for department pricing tools, etc.
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree