Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues
High school diploma or equivalent. 3+ years of claims processing or provider contract experience, preferably in a managed care environment.
- Document, track and resolve all plan providers’ billing and payment issues
- Research verbal and written providers’ claims inquiries
- Collaborate with various business units to resolve claims issues and provide instruction to providers’ billing staff and services regarding claims submission policies and procedures to ensure prompt and accurate claims adjudication
- Identify authorization issues and trends
- Direct and educate Provider Services and Relations with the claims reprocessing notification, utilizing knowledge of provider billing and claims processing
- Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
- Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing
- Identify potential and documented eligibility issues and notify applicable departments to resolve
- Meet with providers to discuss claims payment policies and procedures and resolve claims issues
- Handle provider additions, changes and terminations as identified
- Run claims reports regularly through provider information systems
Centene Corporation - 2 years ago
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...