Charlotte, North Carolina

Position Purpose:

Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract’s negotiated terms.

  • Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
  • Review and price contract related pends to ensure claims payment accuracy
  • Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).
  • Troubleshoot and problem solve contract implementation issues related to basic system configuration
  • Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties.
  • Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
  • Review new and current provider contracts and established state guidelines
  • Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff.

Education/Experience:

Bachelor’s degree in Business, Finance, related field, or equivalent experience. 1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting. Government programs and Amisys experience 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.

Charlotte, North Carolina

Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.

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