Remote Provider Network Engagement Specialist

Peach State Health Plan, Inc.; 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

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.