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Manager, Risk Adjustment Coding Operations

Trillium Community Health Plan Tigard, Oregon

As part of the Customer Service department, you’ll use your knowledge of Centene’s insurance products and service to help our members understand their benefits, details and policy procedures. With your skills, you can help transform the health of every community, one person at a time.

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Our Customer Service Roles

Customer Care Opportunities at Centene

Our Customer Service teams work to ensure high levels of service and customer satisfaction. Learn more about this vital group at Centene

Claims Analyst

As part of a tight-knit team and working as a partner to each provider, you’ll evaluate the needs of your health plan and process all claims in accordance with guidelines.

Claims Liaisons

While ensuring that provider and member requests are taken care of, you’ll review requests from providers and work with state health plans to ensure the accuracy and quality of claims.

Customer Service Representative

You’ll use your healthcare knowledge, analytical skills and our information resources to quickly and correctly answer questions from members and providers.

Enrollment Analyst

You’ll process incoming membership files and focus on maintaining the enrollment integrity of our individual health plan systems.

Systems Solutions Manager

While leading a team of business analysts, you’ll work with the IT department to drive end-to-end solutions for core applications supporting Centene’s operations. Claims Analyst.

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Responsibilities

Job ID 1157255

Category Claims Operations
Schedule Full-time
Description:
Position Purpose: Oversee the risk adjustment coding and data validation programs. Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.

  • Manage daily queue volumes of available medical records in CDMS.
  • Remain aware of company’s state and line of business LOB specific risk adjustment timelines and regulations to ensure data validations, additional codes, and deleted codes are submitted prior to data submissions deadlines.
  • Work with the encounters and risk adjustment analytics departments on risk adjustment data submission.
  • Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of Centene meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements.
  • Oversee quality audits to ensure guidelines set by the state or federal entities are followed, including documentation.
  • Develop and maintain all policy and procedures for new departmental processes.
  • Create various reports using EDW and IT Reporting for monthly distribution to executives, vendor coding partners, and the health plans.
  • Review and approve monthly gap closure reports.
  • Schedule and attend monthly meetings with the health plans to discuss areas of wasteful and abusive coding.
  • Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines.
  • Qualifications:

    Education/Experience: Bachelor’s degree in related field or equivalent experience. 5+ years of medical record audit or related experience. Experience in health plan risk adjustment preferred. Thorough knowledge of administrative, data management and audit functions. Management/supervisory experience preferred.

    Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIA, or CPMA required. CRC or MARSI risk adjustment certification 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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    “Centene has been instrumental in my professional development. I’m pushed in a way that challenges my fears, improve my skills, and enhance my knowledge on healthcare.”

    - Meaghan Hooks, Business Analyst II

    “My job has a direct impact on our providers and members. With every claim paid out the door we are directly helping to save someone’s life!”

    - Jonelle Levy, Business Analyst II

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    “Centene is an exciting company to work for.”

    Esmeralda Baig

    Started as a Case Manager, now a Senior Vice President of Operation

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