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Supervisor, Referral Services

Columbus, Ohio Apply Now Job ID 1150179 Category Leadership Organization Buckeye Community Health Plan Schedule Full-time
Description:
Position Purpose: Supervise the day to day operations of the utilization and case management areas

  • Supervise day to day activities of the Referral Services department including work flow, training, hiring, etc.
  • Assist providers, members and/or internal customers with cases pertaining to referral questions, issues and authorizations
  • Reconcile pended claim issues in a timely manner per health plan/department procedure
  • Review and process denial letters, maintain logs, and coordinate decisions to external or internal personnel per plan procedures
  • Receive and review incoming phone and case management log reports and determine course of action
  • Work with analysts and programmers in adapting and testing programs and procedures to adhere to our standard operating procedures
  • Qualifications:

    Education/Experience: High school diploma or equivalent. 3+ years of prior authorization, physician’s office, customer service, claims processing or provider relations experience preferably in a managed care setting. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

    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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