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Claims Liaison I

Company: Centene Corporation
Location: El Paso
Posted on: April 18, 2019

Job Description:

Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issuesAudit check run and send claims to the claims department for correctionsIdentify any system changes and work notify the Plan CIA Manager to ensure its implementationCollaborate with the claims department to price pended claims correctlyDocument, track and resolve all plan providers' claims projectsCollaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudicationIdentify authorization issues and trends and research for potential configuration related work process changesAnalyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processesIdentify potential and documented eligibility issues and notify applicable departments to resolveResearch the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.Run claims reports regularly through provider information systemsResearch verbal and written providers' claims inquiries as neededFor PA H&W only:Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resourcesCommunicate with providers to exchange info and to gain feedback regarding appropriate claims submission practicesEducation/Experience: High school diploma or equivalent. 3 years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred.For PA H&W only:Must perform work within the state of PennsylvaniaCentene 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.

Keywords: Centene Corporation, El Paso , Claims Liaison I, Other , El Paso, Texas

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