Position Purpose: Manage the Claims Liaison and Provider Data Management department and staff.
Function in the capacity of the claims payment expert for the Plan and as a liaison between the plan, claims, Medical Management Department, Corporate Finance and providers to effectively identify and resolve claims issues. Partner with others in Provider Services/Relations who identify and resolve claims issues, and provide instruction to providers' billing staff and services regarding claims submission policies and procedures to insure prompt and accurate claims adjudication.
Manage the Claims Liaison department and staff and provide expertise to staff to assist in claims issue resolution.
Prioritize work volumes on a daily basis.
Provide Health Plan management with all necessary data to allow for expedient resolution of claims issues & support Health Plan management at all times.
Coordinate documentation, tracking and resolution of all plan providers' billing and payment issues.
Provide expertise and research verbal and written providers' claims inquiries from plan and corporate staff.
Provide expertise to Provider Services/Relations in the identification of Medical Management authorization issues and trends.
Utilizing knowledge of provider billing and claims processing, directs Provider Services/Relations with the claims reprocessing notification.
Track trends in claims processing issues and assist Claims Department in identifying and quantifying issues along with reviewing Claims Department work
Education/Experience: Bachelor's degree in related field or equivalent experience. 7 years of claims processing/researching or provider contract experience in a managed care environment. Management experience strongly 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.