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.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
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
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.
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.
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.
Category Claims Operations
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.
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
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
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“Centene is an exciting company to work for.”
Started as a Case Manager, now a Senior Vice President of OperationSee Esmeralda's career path
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