You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
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.
Our 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 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.
**TITLE:** Contract Implementation Analyst
**LOCATION:** Various, Michigan