NJ Provider Relations & Data Integrity Specialist

centene; New Jersey; 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 seasoned Provider Relations professional to manage provider data setup for state reporting, claims payment, and directories. You will partner with provider networks and external representatives to resolve data issues and ensure accurate records.

The role requires 5+ years in provider services within a managed care environment, with strong contract interpretation skills and cross-functional collaboration.

Qualifications

• Bachelor's degree in healthcare field or equivalent required.
• 5+ years in provider services in a managed health care setting.
• Experience with provider contracting, benefits interpretation, and provider relations operations.

Responsibilities

• Act as internal and external liaison for provider networking and relationships.
• Act as account manager for assigned groups and gatekeeper for other internal departments.
• Oversee daily administration of provider relationships, including training and information to providers.
• Research, analyze and resolve complex provider issues including contracts, rates and eligibility.

Skills

Provider relations

Account management

Data problem-solving

Customer service

Cross-functional communication

Education

Bachelor's degree in healthcare field

Job description

Centene in New Jersey is seeking a seasoned Provider Relations professional to manage provider data setup for state reporting, claims payment, and directories. You will partner with provider networks and external representatives to resolve data issues and ensure accurate records.

The role requires 5+ years in provider services within a managed care environment, with strong contract interpretation skills and cross-functional collaboration.