Job description

You could be the one who changes everything for our 26 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: Independently perform comprehensive audits of claims to source documents and identify incorrect payments

Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
Analyze errors and determine root causes for appropriate classification
Utilize audit software to provide written documentation regarding audit observations
Analyze and review responses to audit observations and facilitate corrective action plans
Monitor state websites and contract changes for impact on claim payments and update audit criteria as necessary
Assist with special projects

Education/Experience: Associate’s degree in related field or equivalent experience. 2+ years of medical or pharmacy claims processing, training or auditing experience. Knowledge of claim software systems, Microsoft Office applications, , Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred. Knowledge of CPT/HCPCS Coding preferred.

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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