Jobs for Humanity is partnering with Centene to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located.

Company Name: Centene

Are you passionate about making a difference in the lives of millions of people? Join our Medical Management/Health Services team at Centene and become the catalyst for positive change for our 28 million members. We are an inclusive organization that values diversity and offers competitive benefits and workplace flexibility.

We are currently seeking a clinical professional to join our team in Oklahoma. Oklahoma Complete Health, a division of Centene, is dedicated to improving the health of Oklahomans through high-quality healthcare solutions.

At Oklahoma Complete Health, we foster an inclusive culture that promotes work-life balance, provides competitive compensation, and offers continuous career development. Join us and become part of a collaborative and growing network of innovative thinkers who are delivering solutions at the local level.

Position Overview:

As a member of our team, you will play a crucial role in resolving time-sensitive authorization issues that impact claim denials, reconsiderations, or appeals. Your responsibilities will include researching the root causes of delays and ensuring all requirements are met within the guidelines.

Key Responsibilities:

• Resolve authorization issues and errors in a timely manner to avoid disruptions in claims processing
• Identify claim issues related to authorizations that affect claims resolution and escalate them as necessary
• Perform outreach, research, and resolution of open or pending authorization issues impacting claim denials, reconsiderations, or appeals
• Review authorization and system errors promptly to ensure compliance with processing requirements
• Provide reports on authorization issues and trends related to claim denials, reconsiderations, and appeals
• Review check runs for claims and ensure accuracy of system configuration
• Carry out other assigned duties and comply with all policies and standards

Requirements:

• High School diploma or GED
• 2-4 years of related experience
• 2+ years of experience in healthcare authorizations, denials, medical claims, coding, and/or collections preferred
• Knowledge of Medicare and Medicaid regulations, insurance processes, medical terminology, and payor compliance rules preferred

What We Offer:

• Flexible work solutions, including remote options and hybrid work schedules
• 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 opportunities

Centene is proud to be an equal opportunity employer that celebrates diversity and values our differences. We are committed to providing equal employment opportunities to all qualified applicants, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.