Senior Manager, Claims & Contract Support
Position Purpose: Manage the implementation all provider contracts, including any pertinent changes and modifications applicable to these contracts. Provide Health Plan management with all necessary data to allow for expedient resolution of claims issues.
- Oversee the claims operation function, including contracting and configuration
- Identify and manage risks, resolve conflicts and remove barriers that impede area's ability to achieve goals and performance expectations
- Provide management to expedite resolution of claims issues and support in policy decisions related to claims operations
- Manage and identify process improvement opportunities in the health plan's workflow to assure timely, accurate submission and implementation of contracts
- Perform random audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
- Act as health plan interface on software product upgrades and implementations that affect contract implementation
- Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations
- Proactively interact with external stakeholders as it relates to new product implementations
- Serve as the subject matter expert in resolution of claims and configuration issues
- Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation
Additional responsibilities for Pennsylvania Health & Wellness:
Manage the day to day responsibilities for the contract implementation and claims resources teams.
Collaborate with the encounters team to ensure encounters are submitted timely and correctly.
Education/Experience: Bachelor's degree in related field or equivalent experience. 6+ years of provider relations, provider contracting or claims administration experience, preferably in a managed care environment. Experience with Medicare and Medicaid claims and system configuration.
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.
Health Insurance Operations
Buckeye Community Health Plan
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