Supervise the day-to-day operations of the utilization and case management areas.
High School education or equivalent. 3-5 years of prior authorization, physician’s office, customer service, claims processing or provider relations experience preferably in a managed care setting. Lead or supervisory experience preferred.
- Supervise day to day activities of the Referral Services department including work flow, training, hiring, etc.
- Assist providers, members and/or internal customers with cases pertaining to referral questions, issues and authorizations.
- Reconcile pended claim issues in a timely manner per health plan/department procedure.
- Review and process denial letters, maintain logs, and coordinate decisions to external or internal personnel per plan procedures.
- Receive and review incoming phone and case management log reports and determine course of action.
- Work with analysts and programmers in adapting and testing programs and procedures to adhere to our standard operating procedures.
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...