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Centene Corporation
Centene Corporation
AsigurăriAsistență medicalăConsultanță
Centene Corporation este o companie de servicii medicale și asigurări axată pe acoperirea finanțată de guvern și pe sănătatea comunităților. Serviciile sale includ Medicaid, Medicare, planuri din cadrul pieței asigurărilor de sănătate și sprijin TRICARE pentru comunitățile militare. Centene combină furnizarea localizată de servicii medicale cu parteneriatele cu organizații nonprofit pentru a răspunde nevoilor membrilor pe care îi deservește. Compania integrează, de asemenea, responsabilitatea față de mediu și guvernanța etică în modul său de operare și de sprijinire a comunităților.
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Senior Quality Auditor - Missouri Remote at Centene

Centene seeks a Senior Quality Auditor to improve healthcare claims accuracy through claims audits, data validation, discrepancy research, and provider data management. The role supports compliant claims processing, quality reporting, and operational improvements.

USStatele Unite ale AmericiiMOMissouri
23 $ – 39 $ / oră
RemoteNormă întreagăSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • Research and analyze data, audits, and business processes to develop effective operational solutions.
  • Audit and validate routine pre- and post-payment claims for accurate adjudication and regulatory compliance.
  • Review provider data entered into claims processing systems for accuracy and completeness.
  • Record audit outcomes and prepare clear reports on findings.
  • Investigate claims and enrollment discrepancies involving provider information.
  • Lead provider data management projects requiring advanced knowledge of provider files and their connection to claims processing systems.
  • Support medical review workflows and cost-saving claims initiatives.
  • Track department metrics for quality improvement, regulatory reporting, and certification requirements.
  • Conduct routine and moderately complex medical review claim audits to identify exceptions.
  • Investigate issues with reviewed claims, determine root causes, and recommend appropriate resolutions.
  • Compile findings and recommendations into reports for management distribution.
  • Share audit and review results with the claims department to strengthen processing and issue resolution.
  • Supply validated data for training materials, policies, and procedures.
  • Maintain up-to-date knowledge of Health Net products, policies, procedures, coding practices, and applicable industry standards.

Cerințe

  • Must be authorized to work in the United States without requiring employment-based visa sponsorship now or later.
  • High school diploma or equivalent qualification.
  • Four years of general data management experience in an automated claims processing, claims research, or provider maintenance environment.
  • Some college coursework is preferred.
  • Working knowledge of Health Net products, policies, and procedures.
  • Knowledge of contract and benefit plan coding.
  • Knowledge of health insurance regulations and certification standards.
  • Ability to audit and validate claims accurately.
  • Ability to investigate claims and enrollment discrepancies involving provider data.
  • Ability to document and communicate audit results.
  • Ability to work remotely from within the continental United States.
  • Preferred working hours align with Central or Eastern Standard Time.

Beneficii

  • Competitive compensation.
  • Health insurance coverage.
  • 401(k) plan.
  • Employee stock purchase plans.
  • Tuition reimbursement.
  • Paid time off and company holidays.
  • Flexible remote, hybrid, field, or office work arrangements.
  • Additional eligible incentives may form part of total compensation.

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