What are the responsibilities and job description for the Claims Liaison I position at Health Net of California?

Position Purpose:

Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

Audit check run and send claims to the claims department for corrections

Identify any system changes and work notify the Plan CIA Manager to ensure its implementation

Collaborate with the claims department to price pended claims correctly

Document, track and resolve all plan providers’ claims projects

Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication

Identify authorization issues and trends and research for potential configuration related work process changes

Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes

Identify potential and documented eligibility issues and notify applicable departments to resolve

Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.

Run claims reports regularly through provider information systems

Research verbal and written providers’ claims inquiries as needed

For PA H&W only:

Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.

Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources

Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

Education/Experience:

High school diploma or equivalent. 3 years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred.

For PA H&W only:
Must perform work within the state of Pennsylvania

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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Claims Liaison I

What are the responsibilities and job description for the Claims Liaison I position at Health Net of California?

Position Purpose:

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