Provider Reimbursement Auditor

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🔥 0 minutes ago

🏄 California, Florida, +2 more states – Remote

🏄 California – Remote 🐊 Florida – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Perform comprehensive audits of provider claims against source documents to identify mis-payments • Conduct quality audits of provider claims, pre- and post-payments, using eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals • Analyze errors and determine root causes for appropriate error responder assignment • Use audit software to provide written documentation regarding audit observations • Analyze and review responses to audit observations to validate accuracy • Provide updates to audit criteria, including maintaining state ACME and reviewing state websites for updates • Document business decisions and identify required updates for department pricing tools • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Associate’s degree in a related field or equivalent experience • 2+ years of medical or pharmacy claims processing or claims pricing experience • Strong Excel skills • Experience with provider claims • Ability to interpret Medicaid and Medicare reimbursement rules • Ability to interpret state and provider contracts • Knowledge of CPT/HCPCS coding preferred • Experience working remotely highly preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules