Provider Reimbursement Auditor

Centene
Florida, Missouri, Texas, California
Workplace: RemoteFull timeUSD 23.23 - 39.61 hourlyFunction: Finance & AccountingExperience: 2+ yearsEducation: associatesSkills: ["Analysis","Attention to detail","Documentation","Remote work experience"]

Perform comprehensive audits of provider claims to source documentation and identify mis-payments. Conduct pre- and post-payment quality audits using eligibility, enrollment, state contracts, provider/facility contracts, and billing manuals; analyze errors to determine root causes and assign appropriate responders. Document audit observations with audit software, review responses for validation, and maintain/update audit criteria and department pricing tools based on state and contract updates.

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FursaFursa
Centene
Centene
2 days ago

Provider Reimbursement Auditor

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Perform comprehensive audits of provider claims to source documentation and identify mis-payments. Conduct pre- and post-payment quality audits using eligibility, enrollment, state contracts, provider/facility contracts, and billing manuals; analyze errors to determine root causes and assign appropriate responders. Document audit observations with audit software, review responses for validation, and maintain/update audit criteria and department pricing tools based on state and contract updates.
Location: Florida, Missouri, Texas, California
Workplace: Remote
Employment Type: Full time
Job Function: Finance & Accounting
Seniority: Mid level

Key Responsibilities

  • •Perform comprehensive audits of provider claims by sourcing documents and identifying mis-payments.
  • •Conduct quality audits of provider claims pre and post payments using eligibility, enrollment, contracts, and billing manuals.
  • •Analyze audit errors, determine root causes, and support appropriate error responder assignment.
  • •Use audit software to produce written documentation of audit observations and validate responses for accuracy.
  • •Update audit criteria and maintain pricing tool updates based on state and contract changes.

Pay and Benefits

Salary: USD 23.23 - 39.61 hourly
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Associate’s degree in a related field or equivalent experience.
  • •2+ years of medical or pharmacy claims processing or claims pricing experience.
  • •Ability to interpret Medicaid and Medicare reimbursement rules and state/provider contracts (preferred).
  • •Strong Excel skills.
  • •Knowledge of CPT/HCPCS coding (preferred).
Experience:2+ yearsHealthcareMedical claimsPharmacy claimsMedicaidMedicare
Education:Associate's
Skills:AnalysisAttention to detailDocumentationRemote work experience
Tech Stack:ExcelAudit software

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn