Provider Data & Engagement Specialist (Remote)

Peach State Health Plan, Inc.; Ohio; Remote; USD 32,000 - 55,000; Full time

Job summary

Centene is seeking a Provider Data Specialist to perform day-to-day duties ensuring provider information is accurate in the provider information system for state reporting, claims payment, and directories. This remote role requires availability during Eastern Standard Time business hours and a willingness to work in the Eastern Time zone.

Key responsibilities include supporting external provider representatives, researching and resolving provider data issues, processing provider

Qualifications

• Associate's degree required; three years of experience in managed care, medical provider office, customer service, and medical claims preferred.

Responsibilities

• Set up providers in the provider information system for state reporting, claims payment, and directories.
• Provide support to external provider representatives to resolve provider data issues.
• Submit provider data entries to resolve provider-related demographic information changes.
• Initiate and process provider add, change and termination forms.
• Create and maintain spreadsheets used to produce provider directories.
• Track, update and audit provider data.
• Research and identify processing inaccuracies in claim payments and route for adjustment.
• Assist providers with website registration and facilitate provider trainings.

Education

Associate's degree

Job description

Centene is seeking a Provider Data Specialist to perform day-to-day duties ensuring provider information is accurate in the provider information system for state reporting, claims payment, and directories. This remote role requires availability during Eastern Standard Time business hours and a willingness to work in the Eastern Time zone.

Key responsibilities include supporting external provider representatives, researching and resolving provider data issues, processing provider