Manager, Denials And Appeals

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.
Must reside in New York State. Occasional travel to the Getzville, NY office.
Position Purpose: Manages the Denials and/or appeals, disputes, and reconsiderations process including the drafting and review of correspondence to ensure regulatory compliance. Manages issues and provides guidance on the review and timely processing to ensure compliance with internal policies and/or procedures according to and National Committee for Quality Assurance (NCQA) requirements.

• Maintains expert knowledge of contract requirements, policies, procedures, and performance standards
• Ensures team's compliance with contract requirements, policies, and procedures
• Reviews reporting and analyzes activities to identify trends and provides recommendations to team
• Provides expert knowledge, guidance and education to team based on experience for any issues or/ questions escalated by external agencies, including state, local, and federal governments
• Works with team and leadership to identify opportunities for process and quality improvement
• Works with leadership team to provide updates and insights on goals and objectives
• Assists with onboarding, hiring, and training Leads and champions change within scope of responsibility
• Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and 5+ years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
2+ years supervisory experience preferred.
Advanced knowledge of NCQA and state Medicaid program requirements preferred.
Advanced knowledge of appeals process 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.
Pay Range: $71,000.00 - $127,500.00 per year
Actual pay will be adjusted based on an individual's skills, experience, education, 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.