Provider Engagement Network Specialist

Peach State Health Plan; Florida; Remote; USD 32,000 - 55,000; Full time

Job summary

Centene is offering a remote provider data support position focused on setting up providers in our information systems for state reporting, claims payment, and directories. You will ensure data accuracy, resolve issues, and process changes and terminations to maintain up-to-date provider records.

The role requires an associate's degree and at least three years of experience in managed care or medical claims, with strong service orientation and attention to detail.

Qualifications

• Associate's degree and claims processing, billing and/or coding experience preferred.
• Three years of experience in a managed care environment, medical provider office, customer service within a healthcare organization, and medical claims.

Responsibilities

• Provide support to the external provider representative to resolve provider data issues.
• Research and effectively respond to provider related 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 for multiple products.
• Track, update and audit provider data.
• Identify adds, deletes and updates to key provider groups and model contract.
• Research and identify processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment.
• Provide assistance to providers with website registration.
• Facilitate provider education via webinar.
• Work with other departments on cross functional tasks and projects.
• Facilitate new provider orientations and trainings.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Claims processing

Billing

Coding

Customer service

Education

Associate's degree

Job description

Position Purpose: Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up.

Key Details: This is a remote position; however, candidates must be willing to work Eastern Standard Time zone business hours.

• Provide support to the external provider representative to resolve provider data issues
• Research and effectively respond to provider related 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 for multiple products
• Track, update and audit provider data
• Identify adds, deletes and updates to key provider groups and model contract
• Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
• Provide assistance to providers with website registration
• Facilitate provider education via webinar
• Work with other departments on cross functional tasks and projects
• Facilitate new provider orientations
• Facilitate provider trainings
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Associate's degree and claims processing, billing and/or coding experience preferred. Three years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims. Knowledge of health care, managed care, Medicare or Medicaid.Pay Range: $23.23 - $39.61 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act