Centene Corporation Behavioral Referral Specialist I in Clayton, Missouri
Receive, review and process Outpatient Treatment Requests (OTR) from providers as it relates to eligibility, benefits and authorization of services. Resolve issues and educate providers on policies and procedures.
Review OTR for accuracy and completeness of data and interact with providers
Perform research for OTR discrepancies as identified by providers
Create member authorizations for approved outpatient therapy services
Verify member eligibility and provider contracting/credentialing status prior to authorizing services
Coordinate outpatient treatment requests with Care Coordination staff for out-of-network providers
Coordinate with eligibility staff for member eligibility discrepancies and update system as necessary
Coordinate outpatient treatment requests with Medical Management team for medical necessity
Modify authorizations as needed to ensure transfer into claims payment system
Identify and refer provider status discrepancies to Provider Relations for follow-up
Ensure established processing timeframes are met for each business unit
Create and maintain reference materials and workflows for data processing
Provide back-up to customer service for increased call volume
Track and maintain monthly reporting log
High school diploma or equivalent. 2+ years of customer service and/or data entry experience. Knowledge of medical/behavioral terms and codes preferred.
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: Behavioral Referral Specialist I
LOCATION: Clayton, Missouri
COMPANY: Clinical & Care Management
POSITION TYPE: Both