You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Generates, processes and maintains complex provider and member correspondence for preservice and concurrent review. Provides guidance and expert knowledge to various teams on correspondence, workflows, inquiries, and escalations.
Generates correspondence for EMR documentation and ensures letters are processed in a timely manner to ensure compliance according to regulatory standards and policies
Oversees the updates to correspondence templates based on regulatory and interdepartmental correspondence inquiries
Coordinates all data collection, analysis, and reporting activities that impact the denial process
Completes the compliance and turn-around time (TAT) log for all correspondence notifications
Assists the correspondence team to triage and determine the root cause of the denial issue with the appropriate department
Responsible for all data collection, analysis, and reporting activities that impact the denial process
Identifies gaps with job aids to ensure compliance
Provides subject matter expertise based on prior experience as well as training to other team members on the reviewing process of correspondence
Reviews complex denials and determines appropriate actions
Manages reporting to identify trends and provides recommendations to various teams
Performs other duties as assigned
Complies with all policies and standards
Schedule: Monday - Friday or Tuesday -Saturday, 10:00am - 7:00pm CST
Education/Experience: Requires a High School diploma or GED. Requires 4+ years of related experience. Expert knowledge of denials process including understanding medical record information preferred. Prior experience generating correspondence in healthcare strongly preferred.
Pay Range: $26.50 - $47.59 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
