NJ Provider Network Engagement Specialist

centene; United States; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene in New Jersey is seeking a Provider Relations Specialist responsible for onboarding and maintaining provider data, supporting state reporting, claims payment, and directories. The role requires residing in NJ and working with provider groups.

You will coordinate with internal departments, resolve contract and data issues, and serve as the liaison between providers and the health plan, ensuring accurate databases and customer-focused service.

Qualifications

• Bachelor's degree in healthcare related field or equivalent experience required.
• 5+ years of provider services experience in a managed health care environment with exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations.

Responsibilities

• Act as internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG's), multi-specialty groups, and/or ancillary providers within assigned area.
• Act as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.
• Responsible for daily administration and operation of the contractual provider relationships, including overseeing accurate and current provider databases, providing training, education and information to providers.
• Research, analyze and resolve complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
• Serve as primary point of contact and liaison between assigned providers and the health plan.
• Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues.
• Act as department subject matter expert.
• Performs other duties as assigned
• Complies with all policies and standards

Education

Bachelor's degree in healthcare related field or equivalent experience

Job description

Centene in New Jersey is seeking a Provider Relations Specialist responsible for onboarding and maintaining provider data, supporting state reporting, claims payment, and directories. The role requires residing in NJ and working with provider groups.

You will coordinate with internal departments, resolve contract and data issues, and serve as the liaison between providers and the health plan, ensuring accurate databases and customer-focused service.