Claims Liaison I

Centene

Job Details

Location: Sunrise, Broward County, Florida, USA Posted: Nov 07, 2019

Job Description

Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

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.

Run claims reports regularly through provider information systems

Research verbal and written providers’ claims inquiries as needed
For 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 resources
Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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