Position Purpose: Assist in coordinating the day-to-day work
function of the assigned claims unit, provide technical support to
staff, and investigate, review and resolve complex issues
Assist in reviewing investigating, adjusting and resolving
complex claims, claims appeals, inquiries, and inaccuracies in
payment of claims
Oversee claims quality reviews for accuracy, document results
and identify trends and systemic root cause analysis
Assist in creating work flows for the department and support
team members in understanding changes in work processes
Primary contact for the team, for the plan and for other
departments in researching, collecting background information and
documentation, to address various issues.
Assists supervisor to research and determine status of medical
claims to assure billed dollars, claims aging, and pend values are
consistent with contract provisions.
Maintains records and reports as assigned
Assist in meeting departmental production and quality
May process claims when needed
Education/Experience: High school diploma or equivalent. 2 years
of claims processing, medical billing, administrative, customer
service, call center, or other office services experience.
Experience operating a 10-key calculator and computers. Ability to
perform basic math functions and reason logically. Knowledge of
ICD-9, CPT, HCPCs, revenue codes, and medical terminology.
Experience with Medicaid or Medicare claims preferred.
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.