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Claims Liaison II

Company: Centene
Location: Eugene
Posted on: November 11, 2019

Job Description:

Claims Liaison II Position Purpose: Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons. Perform various analysis, including reimbursement analysis, interpretation, and subject matter expertise to link business needs and objectives for assigned function. Analyze trends in claims processing issues and identify work process solutions Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track Assist in the writing work processes and continual auditing of the processes to ensure configuration, state mandates, benefits, etc. Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system. Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers' claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc. Travel and in-person provider interaction required Coordinate with various business units and departments in the development and delivery of training programs Diagnose problems and identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Interpret and provide guidance related to provider contract reimbursement with internal partners Coordinate analysis and management of provider reimbursement methodologies and fee schedule updates consistent with DHHS Informational Letters Review, develop and provide subject matter expertise related to provider impact on payment policies and clinical policies Support Provider Relations team responding to provider questions on contracting reimbursement terms, fee schedule coding, and bill requirements Education/Experience: High school diploma or equivalent. 5+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment, Knowledge of provider contracts and reimbursement interpretation preferred. Licences/Certification: CPC certification preferred. 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. Claims Operations USA-Oregon-Eugene Trillium Community Health Plan Full-time

Keywords: Centene, Eugene , Claims Liaison II, Other , Eugene, Oregon

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