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 Corporation - 2 years ago
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Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...