NJ Provider Network Liaison & Data Specialist (Remote)

Socket.dev; New Jersey; On-site; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off & holidays

Flexible work schedules

Job summary

Centene in New Jersey seeks an experienced Provider Relations Manager to ensure accurate provider setup, manage state deliverables, and resolve data issues across provider networks. You will collaborate with physicians, PPGs, and plan administration to maintain current databases and deliver effective provider services.

The role requires a bachelor’s in a healthcare field and at least 5 years in provider relations within managed care.

Qualifications

• Bachelor’s degree in healthcare related field or equivalent experience required.
• 5+ years of provider services experience required.
• 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 and maintain relationships with physicians, PPGs and ancillary providers.
• Act as account manager for assigned groups and serve as gatekeeper for interactions with other internal departments.
• Oversee daily administration and operation of contractual provider relationships, including provider databases and training/education for providers.
• Research, analyze and resolve complex problems involving contract loading, financial responsibility interpretation, contract language, appeals and eligibility.
• Serve as primary point of contact and liaison between providers and the health plan.
• Provide resolution support for complex provider contracts and data issues.
• Act as department subject matter expert.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Provider relations

Account management

Stakeholder liaison

Training

Education

Bachelor's in healthcare

Job description

Centene in New Jersey seeks an experienced Provider Relations Manager to ensure accurate provider setup, manage state deliverables, and resolve data issues across provider networks. You will collaborate with physicians, PPGs, and plan administration to maintain current databases and deliver effective provider services.

The role requires a bachelor’s in a healthcare field and at least 5 years in provider relations within managed care.