Centene Corporation Reimbursement Specialist I, Foundation Care in Earth City, Missouri

HourlyPosition Purpose: Responsible for insurance verification, needed authorizations and billing of all third party payers and patients by performing the following duties. Works across the organization to ensure patient, caregiver, and customer needs are met.

  • Ensures claims are processed in a timely manner

  • Communicates with Pharmacy Benefit Managers and third party payers as needed

  • Follows up with denials and assists with appeals as indicated

  • Processes secondary insurance claims and patient invoices

  • Completes benefits investigations, prior authorizations, and other reimbursement related tasks as applicable

  • Processes copay assistance, patient assistance, first fill assistance, and manufacturer specific program assistance as necessary

  • Ensures third party payer data base is accurate

  • Assists with order fulfillment as assigned

  • Maintenance and upkeep of appropriate documentation required by federal and state agencies

  • Assists in development of systems to maintain and improve reimbursement

  • Observes and complies with all policies and procedures

  • Completes mandatory training requirements

  • Supports quality initiatives as assigned

  • Performs other duties as assigned

Education/Experience: High school diploma or General Education Degree (GED); six months to one year related experience preferred; or equivalent combination of post high school education and experience.

License/Certification: Missouri pharmacy technician registration, to be obtained within 90 days of hire

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: Reimbursement Specialist I, Foundation Care

LOCATION: Earth City, Missouri

REQNUMBER: 1122372

COMPANY: Health Insurance Operations