Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract's negotiated terms.

Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing

Review and price contract related pends to ensure claims payment accuracy

Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).

Troubleshoot and problem solve contract implementation issues related to basic system configuration

Review contracts and assign pay classes and applicable provider information based on contract language.

If configuration is needed to accommodate a contract, notify the appropriate parties.

Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments

Review new and current provider contracts and established state guidelines

Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff
Performs other duties as assigned

Complies with all policies and standards

Education/Experience: Bachelor’s degree in Business, Finance, related field, or equivalent experience. 1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting. Government programs and Amisys experience preferred.

Pay Range: $22.79 - $38.84 per hour

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

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