Centene Corporation 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.

Compliance Investigations Intern (Graduate – Summer)

Description

You could be the one who changes everything for our 28 million members as an Intern at Centene. During this 12-week program, you’ll learn more about Centene and how we’re transforming the health of the community, one person at a time.

Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business.

• Learn various job functions within the Managed Care industry and explore various career opportunities
• Apply academic knowledge and learn new skills by contributing to various projects
• Communicate project status and results to staff mentors and management
• Research various legal, regulatory, and other topics within functional area and industry
• Attend training and development presentations to enhance professional competencies

An Intern in this role can expect to:

• Participate in conflict of interest process and help to mitigate risk to the organization
• Assist with internal sales & marketing investigations
• Develop compliance team trainings & curriculum
• Receive exposure to several areas of managed care compliance for a broad experience

Experience/Experience: Bachelor’s degree or equivalent undergraduate coursework completed. Must be enrolled in a graduate program at an accredited university or college in a field related to the hiring department through the internship period.

The salary range is: $20.00 – $35.00 per hour

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual’s skills, experience, degree program, degree level, number of years of participation in the internship program, and other job-related factors permitted by law

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Pharmacy Operations Coordinator II

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.

Position Purpose: This role will focus on ensuring that the administration of the pharmacy program is accurate and compliant by supporting various operational tasks. This role is also responsible for supporting team members by answering their questions and providing support as needed.

• Pharmacy operations experience focused on the implementation of quality process improvement efforts and with documenting requirements, creating training materials and working directly with end users

• Review benefit/formulary setup and testing (new and year over year)

• Conduct data analysis to support operations
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: High School Diploma or GED, 3+ years of pharmacy experience, preferably in managed care environment

License/Certification: Current state’s Pharmacy Technician license preferredPay Range: $22.36 – $38.07 per hour

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.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Billing Operations Specialist

You could be the one who changes everything for our 28 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.

**Remote Position – Must reside in Tampa, FL area**

Position Purpose: Responsible for billing and reporting to internal and external customers.

• Collaborate with internal team and external client to research and resolve any disputes or discrepancies in billed amounts and/or payment transactions
• Prepare timely and accurate billing for external client
• Document all collections efforts and transaction records
• Reconcile member accounts as needed
• Prepare bad debt write-off as needed
• Research and process refunds as needed
• Maintain low volume in assigned error queues within the billing system
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

• High school diploma or equivalent and 3+ years of combined billing/collections, accounting or customer service experience or Bachelor’s degree in Business Administration or related field.
• Member premium billing experience strongly preferred.
• Medicare or prescription drug insurance experience strongly preferred.
• Call center experience strongly preferred.

Authorization Specialist II

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.

**This is a remote role where candidates can reside anywhere in the United States.**

Position Purpose:

Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
• Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
• Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
• Performs data entry to maintain and update various authorization requests into utilization management system
• Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
• Remains up-to-date on healthcare, authorization processes, policies and procedures
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a High School diploma or GED and requires 1 – 2 years of related experience.

Knowledge of medical terminology and insurance preferred.

Pay Range: $17.00 – $26.00 hourly