Position Purpose: Responsible for the reconciliation of the error authorization report to claims.
Develop and monitor authorization errors trending and patterns by type of error. Provide trending reports to designated management for staff training purposes.
Generate daily authorizations error report, review, correct and reconcile to pay claims
Identify trends and patterns by type of error and provide feedback for staff training purposes and/or system configuration improvement
Conduct investigation related to appropriate coding practices, diagnosis and level of care (LOC) allocation and billing by hospitals in comparison of authorized services
Investigate pended claims for authorization, conduct timely review of authorization module and reconcile for claim payment
Identify and process retrospective authorizations for services not requiring medical review
Enter notes into the claims system (CCMS) system for appropriate claims payment for single case agreements generated by Medical Director
Education/Experience: High school diploma or equivalent. 2 years experience working with ICD-9 codes. Working knowledge of Provider and Claim systems (MACESS, Amysis, CCMS). Claims examiner and/or claims processing experienced 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.