Provider Claim Resolution Analyst
Company: Oklahoma Complete Health
Location: Oklahoma City
Posted on: September 10, 2023
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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
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