Denial Specialist II

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Generates, processes and maintains provider and member correspondence for preservice and concurrent review.

Applicants for this job have the flexibility to work remote from home and preferably reside in Nevada, Oregon or Washington state.

• Generates correspondence from EMR documentation and ensures correspondence tasks are processed in a timely manner to ensure compliance according to regulatory standards and policies

• Updates and maintains correspondence templates based on regulatory, and interdepartmental correspondence inquiries

• Coordinates all data collection, analysis, and reporting activities that impact the denial process

• Assists with the compliance and turn-around time (TAT) log for all correspondence notifications

• Performs other duties as assigned

• Complies with all policies and standards

• Schedule: 10:00am - 7:00pm PST after completion of training, weekend days required

Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of denials process including understanding medical record information preferred. Excel experience is preferred.

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