Claims Research Specialist(Job Number: 1079104)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.Qualifications Education/Experience: High school diploma or equivalent. Bachelor’s degree preferred. 3 years of experience in claims payment processing in government programs and experience in a managed care environment. Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Website : http://www.centene.com
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations