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Centene Corporation

Claims Analyst

Centene Corporation - Great Falls, MT

Claims Analyst

in

Great Falls

Montana

Description:

Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.

Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims.

Research and determine status of medical related claims

Review charges, access the computer system and use payment or denial codes within established department guidelines and standards

Clarify health insurance coverage for coordination of benefits to process claims

Maintain records, files, and documentation as appropriate

Meet department production and quality standards

Qualifications:

Education/Experience: High school diploma or equivalent. 1 years of claims processing, medical billing, administrative, customer service, call center, or physician s office or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims 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.

Job:

Claims Operations

Organization:

G&A-Claims-Montana

Location:

Montana-Great Falls

Requisition ID:

1069976

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Claims Analyst Centene Corporation - Great Falls, MT, United States

   

Location: Great Falls, MT

Company Profile:
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations