Centene Corporation Albuquerque , NM 87102
Position Purpose: Lead and oversee the implementation all provider contracts, including any pertinent changes and modifications applicable to these contracts. Serve as the subject matter expert on all contract implementation related issues and questions.
Lead and oversee the internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation
Manage the health plan's workflow to assure timely, accurate submission and implementation of contracts
Participate in provider contracting activities & provide technical support with internal departments to improve communication and minimize contract implementation issues/errors
Act as the health plan interface with Corporate Contracting and other business owners for all questions regarding implementation and claims accuracy issues
Act as health plan interface on software product upgrades/implementations which affect contract implementation
Assess state changes in reimbursement and/or benefits and request appropriate changes to configuration to correctly & timely implement these changes.
Ensure accurate contract implementation and subsequent claims processing through post production audits of claims payment, provider setup, UAT testing, etc.
Develop, communicate, implement and maintain production and quality standards
Education/Experience: Bachelor's degree in business, finance, related field or equivalent experience. 4 years of provider contract implementation, contract analysis, or claims payment system experience in managed care, health care, or TPA setting.
Understanding of rate methodology and contract language. Strong problem solving and analytical skills. Government programs and Amisys experience 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.