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Manager, Claims Configuration

Columbus, Ohio Apply Now Job ID 1151452 Category Leadership Organization Buckeye Community Health Plan Schedule Full-time
Description:

Position Purpose: Manage and oversee the implementation of all provider contracts

  • Perform random audits of provider setup within the provider information system (AMISYS) to ensure accurate contract implementation and subsequent claims processing
  • Ensure accurate contract implementation and subsequent claims processing thru activities like provider setup, UAT testing, etc
  • Manage the health plan’s workflow to assure timely, accurate submission and implementation of contracts.
  • Develop, communicate, implement and maintain production and quality standards for staff, such as Contract Implementation Specialists and other staff as assigned
  • Act as health plan interface on software product upgrades/implementations which affect contract implementation
  • Monitor, track, and communicate state changes in reimbursement or benefits to responsible parties
  • Act as the health plan interface with Corporate Contracting and other business owners as applicable for all questions regarding implementation and claims accuracy issues
  • Document and report deviations as well as coordinate the business process of such deviations from contract standards ensuring that they have appropriate approval and can be effectively administered prior to execution
  • Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation

  • Qualifications:


    Education/Experience: Bachelor’s degree in related area or equivalent experience. 4+ years of provider contract implementation, contract analysis, or claims payment system experience in managed care, health care, or TPA setting. Understanding of rate methodology and contract language. Strong problem solving and analytical skills. Government programs (i.e., Medicaid) and Amysis 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.

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