Serve as the subject matter expert on claims knowledge to address proficiency gaps on the floor in a timely manner.
Provide in-person and virtual training as needed to support claims training. Act as a support to the Claims Training team by conducting regular reviews of the work processes to ensure accuracy.
Review, investigate, adjust and resolve claims, claims appeals, inquiries, and inaccuracies in payment of claims.
Review specific claim categories to i)-validate interest payments (including high dollar interest and U9 interest payment reviews), ii)-validate authorization denials to ensure prober processing of claims, iii)-validate claims prior to check runs, etc.
Conduct claims quality reviews for processing for accuracy. Document results and identify trends/systemic root cause analysis
Maintain appropriate records, files, documentation, etc.
Meet established quality, turn-around time and interest reduction metrics Review and process complex claims for adjudication, coding compliance and reimbursement. Serve as the point of contact for Claims Analyst for all questions related to claims activities and processes.
High school diploma or equivalent. Associate's degree preferred. 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-10, CPT, HCPCs, revenue codes, and medical terminology.
Experience with Medicaid or Medicare claims preferred. Experience operating a 10-key calculator and computers.
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.