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Centene Corporation Claims Liaison II in Eugene, Oregon


Position Purpose:

Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons.

Perform various analysis, including reimbursement analysis, interpretation, and subject matter expertise to link business needs and objectives for assigned function.

Analyze trends in claims processing issues and identify work process solutions

Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track

Assist in the writing work processes and continual auditing of the processes to ensure configuration, state mandates, benefits, etc.

Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.

Audit check run and send claims to the claims department for corrections

Identify any system changes and work notify the Plan CIA Manager to ensure its implementation

Collaborate with the claims department to price pended claims correctly

Document, track and resolve all plan providers’ claims projects

Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication

Identify authorization issues and trends and research for potential configuration related work process changes

Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes

Identify potential and documented eligibility issues and notify applicable departments to resolve

Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.

Travel and in-person provider interaction required

Coordinate with various business units and departments in the development and delivery of training programs

Diagnose problems and identify opportunities for process redesign and improvement

Formulate and update departmental policies and procedures

Interpret and provide guidance related to provider contract reimbursement with internal partners

Coordinate analysis and management of provider reimbursement methodologies and fee schedule updates consistent with DHHS Informational Letters

Review, develop and provide subject matter expertise related to provider impact on payment policies and clinical policies

Support Provider Relations team responding to provider questions on contracting reimbursement terms, fee schedule coding, and bill requirements

Education/Experience: High school diploma or equivalent. 5+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment, Knowledge of provider contracts and reimbursement interpretation preferred.

Licences/Certification: CPC certification preferred. Valid Driver’s License is required for Superior Health Plan.

Claims Administration / Corporate: Customer service, data entry, data analysis for trending and tracking, and/or root cause analysis. The ability to disseminate information across a wide variety of audiences. The ability to prioritize work and successfully handle issue resolution in a timely manner.

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.

TITLE: Claims Liaison II

LOCATION: Eugene, Oregon

REQNUMBER: 1152844

COMPANY: Claims Operations