Remote Provider Data & Network Specialist

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

Job summary

Centene is seeking a Provider Data Specialist to ensure accurate setup of provider records in the provider information system for state reporting, claims payment, and directories. This remote role requires timely processing and cross-functional collaboration to maintain data integrity.

You will handle provider data entries, add/change/termination forms, and support provider registration and education sessions.

Qualifications

• Associate's degree required or preferred.
• Three years of experience in 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 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.
• 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.

Education

Associate's degree

Job description

Centene is seeking a Provider Data Specialist to ensure accurate setup of provider records in the provider information system for state reporting, claims payment, and directories. This remote role requires timely processing and cross-functional collaboration to maintain data integrity.

You will handle provider data entries, add/change/termination forms, and support provider registration and education sessions.