You are an experienced professional with a bachelor’s degree in health services or healthcare administration and at least two years of direct experience in medi
Work type: onsite
Location: Rego Park - New York City Regional Office-95-25 Queens Blvd(10815)
Salary: $56,200 – $101,000/yr
Type: Full-time
You are an experienced professional with a bachelor’s degree in health services or healthcare administration and at least two years of direct experience in medical claims review or appeals. This role is built for someone who understands the complexities of provider relations and managed care operations. **What makes it worth a look...** Centene offers a salary range of $56,200 to $101,000 per year for this role. While based out of a regional office in Rego Park, New York, the position offers a flexible work environment with the ability to work remotely, provided you reside in the tri-state area. **You might be a good fit if you...** * Possess two or more years of professional experience specifically in medical claims review or appeals. * Demonstrate proficiency in interpreting complex provider contracts and health policy documents. * Have a track record of managing root cause analysis and implementing corrective action plans for clinical claims. * Are comfortable conducting site visits and participating in formal provider network meetings.
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.Applicants for this job have the flexibility to work remote from home and preferably reside in New York or within the tri-state area.Position Purpose: Maintains relationships with physicians, hospitals, ancillary providers and Health Net's internal Provider Network Management Dept. Acts as first line contact for providers/hospitals on claims projects and other non-routine claim issues. Oversees, in conjunction with the Adjustment and New Day Unit Supervisors, resolution of project issues and is responsible to communicate final resolution to the provider/hospital or other business units and/or managers, as needed and/or as required. Assists with policy and procedure interpretation. Researches, analyzes and resolves complex problems with claims development and finalization.
Pay Range: $56,200.00 - $101,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.