Remote Provider Data & Directory Specialist

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

Job summary

Centene is seeking a Provider Data Specialist to ensure accurate setup of providers in the provider information system for state reporting, claims payment, and directories. This remote role requires availability during Eastern Time business hours.

The position involves supporting external provider representatives, researching issues, processing provider data entries and add/change/termination forms, and maintaining provider directories across multiple products.

Qualifications

• Associate's degree required; claims processing, billing and/or coding experience preferred.
• Three years of experience in managed care environment, medical provider office, or healthcare customer service.
• Knowledge of health care, managed care, Medicare or Medicaid.

Responsibilities

• Provide support to external provider representatives to resolve data issues.
• Research and 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 site operations for 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.

Skills

Claims processing

Billing

Coding

Customer service

Healthcare knowledge

Education

Associate's degree

Job description

Centene is seeking a Provider Data Specialist to ensure accurate setup of providers in the provider information system for state reporting, claims payment, and directories. This remote role requires availability during Eastern Time business hours.

The position involves supporting external provider representatives, researching issues, processing provider data entries and add/change/termination forms, and maintaining provider directories across multiple products.