Manager, Denials and Appeals
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Must live in OklahomaOklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development.
Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.
Position Purpose:
Manages the denials and/or appeals, disputes, and reconsiderations process including the drafting and review of correspondence to ensure regulatory compliance.
Manages issues and provides guidance on the review and timely processing to ensure compliance with internal policies and/or procedures according to and National Committee for Quality Assurance (NCQA) requirements.
Maintains expert knowledge of contract requirements, policies, procedures, and performance standards Ensures team's compliance with contract requirements, policies, and procedures Reviews reporting and analyzes activities to identify trends and provides recommendations to team Provides expert knowledge, guidance and education to team based on experience for any issues or/ questions escalated by external agencies, including state, local, and federal governments Works with team and leadership to identify opportunities for process and quality improvement Works with leadership team to provide updates and insights on goals and objectives Assists with onboarding, hiring, and training Leads and champions change within scope of responsibility Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines Performs other duties as assigned Complies with all policies and standards Education/
Experience:
Requires a Bachelor's degree and 5
years of related experience or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
2
years supervisory experience preferred.
Advanced knowledge of NCQA and state Medicaid program requirements preferred.
Advanced knowledge of appeals process preferred.
Oklahoma Complete Health Only:
Clinician with current state licensure requiredPay Range:
$71,000.
00 - $127,500.
00 per yearOur Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
Total compensation may also include additional forms of incentives.
Recommended Skills Leadership Medicaid Quality Management Onboarding Regulatory Compliance Appeals Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
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on('click', function (event) window.
ExternalApply = window.
open('/interstitial?jobdid=j3m1n86vn1lqvm443cf', 'ExternalApply-j3m1n86vn1lqvm443cf'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Must live in OklahomaOklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development.
Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.
Position Purpose:
Manages the denials and/or appeals, disputes, and reconsiderations process including the drafting and review of correspondence to ensure regulatory compliance.
Manages issues and provides guidance on the review and timely processing to ensure compliance with internal policies and/or procedures according to and National Committee for Quality Assurance (NCQA) requirements.
Maintains expert knowledge of contract requirements, policies, procedures, and performance standards Ensures team's compliance with contract requirements, policies, and procedures Reviews reporting and analyzes activities to identify trends and provides recommendations to team Provides expert knowledge, guidance and education to team based on experience for any issues or/ questions escalated by external agencies, including state, local, and federal governments Works with team and leadership to identify opportunities for process and quality improvement Works with leadership team to provide updates and insights on goals and objectives Assists with onboarding, hiring, and training Leads and champions change within scope of responsibility Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines Performs other duties as assigned Complies with all policies and standards Education/
Experience:
Requires a Bachelor's degree and 5
years of related experience or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
2
years supervisory experience preferred.
Advanced knowledge of NCQA and state Medicaid program requirements preferred.
Advanced knowledge of appeals process preferred.
Oklahoma Complete Health Only:
Clinician with current state licensure requiredPay Range:
$71,000.
00 - $127,500.
00 per yearOur Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
Total compensation may also include additional forms of incentives.
Recommended Skills Leadership Medicaid Quality Management Onboarding Regulatory Compliance Appeals Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
external-apply-email-saved').
on('click', function (event) window.
ExternalApply = window.
open('/interstitial?jobdid=j3m1n86vn1lqvm443cf', 'ExternalApply-j3m1n86vn1lqvm443cf'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
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