Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Claims Liaison I

Expired Job

Centene Corporation Rancho Cordova , CA 95741

Posted 3 months ago

Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

Audit check run and send claims to the claims department for corrections

Identify any system changes and work notify the Plan CIA Manager to ensure its implementation

Collaborate with the claims department to price pended claims correctly

Document, track and resolve all plan providers' claims projects

Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication

Identify authorization issues and trends and research for potential configuration related work process changes

Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes

Identify potential and documented eligibility issues and notify applicable departments to resolve

Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.

Run claims reports regularly through provider information systems

Research verbal and written providers' claims inquiries as needed

For PA H&W only:

Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.

Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources

Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

Education/Experience: High school diploma or equivalent. 3 years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred.

For PA H&W only:

Must perform work within the state of Pennsylvania

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.


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Assistant Entry Level

Sedgwick Claims Management Services, Inc.

Posted 5 days ago

VIEW JOBS 12/11/2018 12:00:00 AM 2019-03-11T00:00 Claims Assistant IF YOU CARE, THERE'S A PLACE FOR YOU HERE For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others. PRIMARY PURPOSE: To provide support to the claims staff and to perform other office tasks depending on the client program. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Sets up and enters new claims into claims management system. * Inputs and reviews notes/diaries in claims management system as instructed. * Processes payments. * Processes mail; handles filing, faxing and photocopying. * Reviews, prepares, creates, and/or sends letters, reports, and forms. * Answers and initiates telephone calls, sets up medical appointments, and may provide customer service as required. * Other activities/projects as assigned including the preparation and distribution of computer reports. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). QUALIFICATIONS Education & Licensing High school diploma or GED required. Experience Six (6) months of clerical or customer service experience or equivalent combination of education and experience required. Skills & Knowledge * Excellent oral and written communication * PC literate, including Microsoft Office products * Strong organizational skills * Ability to work in a team environment * Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace Sedgwick Claims Management Services, Inc. Rancho Cordova CA

Claims Liaison I

Expired Job

Centene Corporation