You Could Make a Difference
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Location Requirement
Must live in Oklahoma
About Oklahoma Complete Health
Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
Join Our Inclusive Culture
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.
Position Purpose
- Resolves time-sensitive authorization issues that impact claim denials, reconsiderations, or appeals.
- Researches root causes for delays in authorization process and ensures all requirements are completed in accordance with guidelines.
- Ensures all assigned authorization issues and/or errors are resolved within appropriate the time frame to avoid interference with the processing of claims.
- Identifies claim issues related to authorizations that impact the resolution of claims and escalates as appropriate.
- Performs outreach, researches, and resolves all open or pending authorization issues that impact claim denials, reconsiderations, or appeals.
- Reviews authorization and system errors and resolves in a timely manner to ensure processing requirements are in accordance with guidelines.
- Provides reporting on authorization issues and trends identified related to claim denials, reconsiderations, and appeals.
- Reviews check runs for claims and system configuration accuracy.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience
- Requires a High School diploma or GED.
- Requires 2 – 4 years of related experience.
- 2+ years experience in healthcare authorizations, denials, medical claims, coding and/or collections preferred.
- Knowledge of Medicare and Medicaid regulations, insurance processes, medical terminology and payor compliance rules preferred.
Comprehensive Benefits Package
Our Comprehensive Benefits Package includes:
- 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.
Apply Now