Remote Provider Data & Network Specialist

Centene Corp.; United States; Remote; USD 32,000 - 55,000; Full time

Job summary

Centene Corp. is seeking a Provider Data Specialist to ensure accurate setup of provider records in the information system for state reporting, claims payment, and directories.

This remote role requires EST business hours and collaboration with multiple internal teams. Ideal candidates will have an Associate's degree and 3+ years in managed care or healthcare customer service, with experience in provider data, billing, and claims issues.

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, or healthcare customer service.
• Knowledge of health care, managed care, Medicare or Medicaid.

Responsibilities

• Provide support to external provider representatives to resolve provider data issues.
• Research and respond to provider related issues effectively.
• Submit provider data entries to resolve demographic information changes.
• Initiate and process provider add/change/termination forms.
• Create and maintain spreadsheets for provider directories.
• Track, update and audit provider data.
• Identify adds, deletes and updates to key provider groups and model contracts.
• Research and identify processing inaccuracies in claim payments and route for adjustment.
• Assist providers with website registration.
• Facilitate provider education via webinars.
• Coordinate cross functional tasks with other departments.
• Facilitate new provider orientations and trainings.
• Perform other duties as assigned and comply with policies and standards.

Skills

Provider data management

Claims processing

Customer service

Webinar facilitation

Education

Associate's degree

Job description

Centene Corp. is seeking a Provider Data Specialist to ensure accurate setup of provider records in the information system for state reporting, claims payment, and directories.

This remote role requires EST business hours and collaboration with multiple internal teams. Ideal candidates will have an Associate's degree and 3+ years in managed care or healthcare customer service, with experience in provider data, billing, and claims issues.