Submission for the position: Lead Provider Reimbursement Auditor - (Job Number: 1325978)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1325978&lang=en
Lead Provider Reimbursement Auditor
Position Purpose:
• Perform, lead and report on provider reimbursement audits of claims to identify mis-payments, and report to management
• Audit provider claims involving products with complex provider reimbursement rules for payment accuracy to source documents (e.g. contracts)
• Estimate the impact of errors, validate corrective actions and recommend action plans
• Analyze claim trends and develop reports to summarize findings
• Assist with conducting meetings with functional areas to resolve audit errors
• Assist with performing audits on the accuracy of claim system set-up
• Evaluate department audit processes and identify process improvements
• Assist with providing updates to audit criteria
• Mentor, train and facilitate work of staff auditors
• Assist in development of audit programs for new markets/products
Education/Experience: Associate’s degree in related field or equivalent experience. 6 years of medical or pharmacy claims processing or claims pricing experience. Microsoft Office applications, Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred. Knowledge of CPT/HCPCS Coding 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-Florida-Tampa
USA-Missouri-Clayton, USA-Connecticut-Farmington, USA-California-Sacramento
Schedule: Full-time Location(s): USA-Florida-Tampa