Senior Claims Support Analyst

Centene Corporation Farmington , MO 63640

Posted 3 months ago

Position Purpose:

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.

Education/Experience:

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.



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
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 Analyst

Centene Corporation

Posted 3 weeks ago

VIEW JOBS 12/28/2019 12:00:00 AM 2020-03-27T00:00 Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures. Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims. Research and determine status of medical related claims Review charges, access the computer system and use payment or denial codes within established department guidelines and standards Clarify health insurance coverage for coordination of benefits to process claims Maintain records, files, and documentation as appropriate Meet department production and quality standards Education/Experience: High school diploma or equivalent. 1 years of claims processing, medical billing, administrative, customer service, call center, or physician's office or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims 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. Centene Corporation Farmington MO

Senior Claims Support Analyst

Centene Corporation