Claims Research Specialist

Centene

Job Details

Location: Burr Ridge, DuPage County, Illinois, USA Posted: Nov 17, 2019

Job Description

Position Purpose: Perform duties to act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries.

Receive and respond to internal and external claims related issues.

Initiate entry or change of provider related database information.

Complete claims related research projects.

Assist with responsibilities related to data integrity of provider claims processing system.

Investigate and communicate reimbursement and benefit changes.

Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission.

Assist providers with resolving issues with claims submission and payment accuracy.

Attend state meetings with regards to fee schedule and benefit changes.

Assist with provider complaints & resolutions regarding claims issues and process claims adjustments.

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

About Centene

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

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