Remote Provider Relations & Contracts Specialist

Centene Management Company LLC; Pennsylvania; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

PTO + holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in Pennsylvania seeks a Provider Data Specialist to perform day-to-day duties ensuring providers are accurately set up in the provider information system for state reporting, claims payment, and directories. The role requires 5+ years in provider services and a healthcare-related bachelor's degree, with remote work and occasional travel.

You will serve as liaison with physicians and provider groups, manage provider databases, resolve data issues, and support

Qualifications

• Bachelor’s degree in healthcare related field or equivalent experience.
• 5+ years of provider services experience in a managed health care environment.
• Residence in Western/Southwestern Pennsylvania; remote role with occasional travel.

Responsibilities

• Act as internal and external liaison for provider networking and maintain relationships with physicians, PPGs, and ancillary providers.
• Serve as account manager for assigned groups as gatekeeper for interactions with other departments.
• Oversee daily administration and operation of provider relationships, including accurate and current provider databases, training and information for providers.
• Research, analyze and resolve complex problems related to contract loading, financial responsibility interpretation, contract rate and language interpretation, appeals and eligibility.
• Serve as primary contact between providers and the health plan; provide issue resolution for provider data and claims.

Skills

Provider relations

Account management

Data administration

Issue resolution

Education

Bachelor’s degree in healthcare related field

Job description

Centene Management Company LLC in Pennsylvania seeks a Provider Data Specialist to perform day-to-day duties ensuring providers are accurately set up in the provider information system for state reporting, claims payment, and directories. The role requires 5+ years in provider services and a healthcare-related bachelor's degree, with remote work and occasional travel.

You will serve as liaison with physicians and provider groups, manage provider databases, resolve data issues, and support