Centene Corporation

  • Tacoma, WA, USA
Dec 06, 2021
Centene Corporation Remote * (Freeburg, IL 62243, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to unfavorable audit scores. . Essential Functions : Assists Quality Auditors with questions, casework, and complex cases. Conducts complex and routine quality reviews of staff level work. Tracks and maintains quality results for appropriate distribution....
Dec 06, 2021
Centene Corporation Remote * (Coosawhatchie, SC 29912, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to...
Dec 06, 2021
Centene Corporation Remote * (Jacksonboro, SC 29474, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to...
Dec 06, 2021
Centene Corporation Remote * (St. Louis, MO, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to unfavorable audit scores. . Essential Functions : Assists Quality Auditors with questions, casework, and complex cases. Conducts complex and routine quality reviews of staff level work. Tracks and maintains quality results for appropriate distribution....
Dec 06, 2021
Centene Corporation Remote * (Dupo, IL, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to unfavorable audit scores. . Essential Functions : Assists Quality Auditors with questions, casework, and complex cases. Conducts complex and routine quality reviews of staff level work. Tracks and maintains quality results for appropriate distribution....
Dec 06, 2021
Centene Corporation Remote * (4411 Green Pond Rd, Easton, PA 18045, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to...
Dec 06, 2021
Centene Corporation Remote * (Sheldon, IA 51201, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to...
Dec 06, 2021
Centene Corporation Remote * (Del Valle, TX, USA)
*Applicants for this job have flexibility to work from home within commutable distance to the office. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Generate and process denial letters and Notice of Action (NOA) for pre services, leveling of care and denied medical services. Maintain the denial and/or appeals logs and assessments in accordance with associated guidelines Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance Serve as the department liaison for all denial and/or appeals issues Train others on denial...
Dec 06, 2021
Centene Corporation Remote * (Fenton, MI, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* Position Purpose : Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to unfavorable audit scores. . Essential Functions : Assists Quality Auditors with questions, casework, and complex cases. Conducts complex and routine quality reviews of staff level work. Tracks and maintains quality results for appropriate distribution....
Dec 06, 2021
Centene Corporation Remote * (Driftwood, TX 78619, USA)
*Applicants for this job have flexibility to work from home within commutable distance to the office. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Generate and process denial letters and Notice of Action (NOA) for pre services, leveling of care and denied medical services. Maintain the denial and/or appeals logs and assessments in accordance with associated guidelines Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance Serve as the department liaison for all denial and/or appeals issues Train others on denial...
Dec 06, 2021
Centene Corporation Remote * (Hutto, TX 78634, USA)
*Applicants for this job have flexibility to work from home within commutable distance to the office. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Generate and process denial letters and Notice of Action (NOA) for pre services, leveling of care and denied medical services. Maintain the denial and/or appeals logs and assessments in accordance with associated guidelines Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance Serve as the department liaison for all denial and/or appeals issues Train others on denial...
Dec 06, 2021
Centene Corporation Remote * (Van Nuys, Los Angeles, CA, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking,...
Dec 06, 2021
Centene Corporation Remote * (Austin, TX, USA)
*Applicants for this job have flexibility to work from home within commutable distance to the office. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose : Generate and process denial letters and Notice of Action (NOA) for pre services, leveling of care and denied medical services. Maintain the denial and/or appeals logs and assessments in accordance with associated guidelines Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance Serve as the department liaison for all denial and/or appeals issues Train others on denial...
Dec 06, 2021
Centene Corporation Remote * (Vero Beach, FL, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail Our Comprehensive Benefits Package: Flexible work...
Dec 06, 2021
Centene Corporation Remote * (Charlotte, NC, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you will have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs complex and routine quality audits in Appeals for one of the following teams; par provider, non-par provider and/ or members using databases and a prescriptive audit tool to verify the completeness, accuracy and adherence to regulations, departmental procedures and documentation guidelines of randomly selected appeal files. Documents and reports findings by individuals and teams. Provides feedback and recommends improvements within the department. When indicated, gives one-on-one training in response to...
Dec 06, 2021
Centene Corporation Remote * (Dallas, TX, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.*You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.**Position Purpose:**Make outbound calls and provide informatio
Dec 06, 2021
Centene Corporation Remote * (Intercession City, FL 33848, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Respond to customer inquiries and/or verify information via telephone and written correspondence. Initiate and respond to telephone and written correspondence with members, providers and/or other insurance carriers within established timeframes utilizing current reference materials and available resources. Process correspondence, provide the appropriate level of updates via tracking systems and follow up with the initiating party. Maintain performance and quality standards based on established metrics, including...
Dec 06, 2021
Centene Corporation Remote * (Elfers, FL, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters Provide assistance to members and/or providers regarding website registration and navigation Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources,...
Dec 06, 2021
Centene Corporation Remote * (Largo, FL, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters Provide assistance to members and/or providers regarding website registration and navigation Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources,...
Dec 06, 2021
Centene Corporation Remote * (Crystal Springs, FL 33540, USA)
*Applicants for this job have flexibility to work from home anywhere in the United States. This job is eligible for a $3,000 sign-on bonus.* You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters Provide assistance to members and/or providers regarding website registration and navigation Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources,...