Provider Claim Resolution Analyst

Company: Oklahoma Complete Health
Location: Oklahoma City
Posted on: September 10, 2023

Job Description:

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.

At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development. Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.

***Must Reside in Oklahoma***

Position Purpose: Oversee the reimbursement strategies and overpayment recoveries. Responsible for providing claims coding, and pricing expertise to initiatives and act as key contact for third party vendor recovery activities.--- Serve as subject matter expert on claims edits for State providers as it relates to third party edits on fraud and abuse software
--- Educate providers ,resolve claims questions and disputes, manage and monitor the day to day work functions of the member and provider services and claim liaison areas
--- Serve as subject matter expert for strategic provider relationships, service issues, reimbursement and claims
--- Perform necessary reviews and initiate discussion with providers as needed on encounter scrubs and pends
--- Track and trend system issues, so that provider education can be performed and/or system reconfiguration be requested
--- Develop policies, procedures and performance standards for the department in compliance with Federal, State and Company regulations
--- Oversee claim projects, pricing issues and documenting trends for contract implementation on system issues and provider education
--- Monitor claims processing activities for the claims unit
--- Oversee the development and execution of overpayments strategies to generate medical savings
--- Serve as a liaison for medical management and provider relations to develop and implement strategies for maximizing coordination of benefits opportunitiesEducation/Experience: Bachelor's degree in Business Administration, Healthcare Administration, related field or equivalent experience. 5+ years of healthcare claims processing and coding experience. Working knowledge of both state reimbursement methodology and CMS claims policy.Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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.

Keywords: Oklahoma Complete Health, Oklahoma City , Provider Claim Resolution Analyst, Professions , Oklahoma City, Oklahoma