You could be the one who changes everything for our 28 million members
Join our Medical Management/Health Services team at Centene, a diversified national organization offering competitive benefits and a fresh perspective on workplace flexibility.
Position Purpose:
Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and inservices as directed. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
- Screen for eligibility and benefits.
- Identify members without a PCP and refer to Member Services.
- Answers phone queues and faxes within established standards.
- Screen members by priority for CM assessment.
Coordinates services with community-based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Helps develop marketing and outreach meetings as directed to represent the health plan.
- Train new Program Coordinators on system and usage.
- Guide staff regarding benefits, authorization requirements, and policy and procedure.
Data enters assessments and authorizations into the system. Maintains the database as directed.
Education/Experience:
High school diploma or equivalent; 3-5 years managed care setting, medical office, or facility setting with a demonstration of medical administration duties. Thorough knowledge of customer service, utilization review, or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
Preferred Qualifications:
- 3+ years of experience working with ALL three lines of business: Medicaid, Medicare, and Marketplace.
- Must be highly adaptable/flexible to changes and skilled at learning new processes.
- Role requires strong administrative support, organizational, and time management skills.
- Building authorizations and resolving authorizations in Trucare according to Auth guidelines is preferred.
- Requires the ability to multi-task, navigate, and conduct research in Amisys, Omni, and Medicaid state websites.
- Excellent verbal and written communication skills.
- Ability to work independently.
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.
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