Encounters Liaison

Company: Centene
Location: Rocky Mount
Posted on: March 21, 2020

Job Description:

Encounters Liaison Position Purpose: Identify, analyze, and resolve provider claims and encounter submission issues. Act as a liaison between the plan, claims, providers and various departments to effectively resolve claims and encounters issues. - Research and resolve complex provider claims inquiries and pending or denied encounters - Track trends in claims processing and encounter submission issues, assist in identifying and quantifying solutions, make recommendations, and assist with implementations - Research and resolve systemic issues that may impact state compliance - Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing - Establish and monitor prioritization process to reduce backlog of encounters projects - Assist with reviews and initiate discussion with providers as needed on encounter scrubs and pends - Lead claim projects, pricing issues and documenting trends for contract implementation on system issues and provider education - Assist with provision of Medicare coverage and services Education/Experience: Associate's degree in Business Administration, Health Care Administration, related field, or equivalent experience. 4+ years of combined claims processing and data analysis or related insurance experience. Lead or supervisory experience preferred. 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. Claims Operations USA-North Carolina-Rocky Mount USA-North Carolina-Raleigh Envolve Vision Full-time

Keywords: Centene, Rocky Mount , Encounters Liaison, Other , Rocky Mount, North Carolina