locations
Remote-MO
Remote-FL
Remote-TX
time type
Full time
posted on
Posted Today
job requisition id
1566904
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.
Position Purpose: Supervises drafting and processing of correspondence in accordance with National Committee for Quality Assurance (NCQA) requirements. Supervises day-to-day activities and provides guidance to the team to ensure correspondence is reviewed and processed timely.
Applicants for this job have the flexibility to work remote from home anywhere in the United States.
Monitors and tracks all correspondence issues and researches to ensure documentation, processing, and resolution is in accordance with established policies and procedures
Provides expert knowledge and guidance based on experience to the correspondence team for issue resolution and processing to ensure compliance with state and National Committee for Quality Assurance (NCQA) requirements
Maintains knowledge of contract requirements, policies, procedures, and ensures correspondence team’s compliance with contract requirements, policies, procedures, and performance standards
Works with team to identify opportunities for process and quality improvements within the denial processing and review process
Evaluates team performance and provides feedback regarding performance, goals, and career milestones
Provides coaching and guidance to team to ensure timely documentation for services and improve processing and quality of correspondence
Assists with onboarding, hiring, and training of team members
Leads and champions change within scope of responsibility
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires a Bachelor's degree and 4+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Knowledge of NCQA, federal, and state requirements preferred. Knowledge of denials process preferred. Compact RN license required.
Pay Range: $62,400.00 - $112,400.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act