Remote Senior Provider Network Engagement Specialist

Centene Corporation; Florida; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation is seeking a Provider Relations Specialist to ensure accurate provider setup in the information system for state reporting and claims processing. The role involves coordinating with providers, internal departments, and external representatives to resolve data issues and maintain current provider databases.

Requirements include a healthcare-related bachelor's degree or equivalent experience and 5+ years in provider services within a managed care environment, including

Qualifications

• Bachelor's degree in healthcare related field or equivalent experience is required.
• 5+ years of provider services experience in a managed health care environment, including contracting, benefits interpretation and provider relations operations.

Responsibilities

• Act as internal and external liaison for provider networking and relationships within assigned area.
• Manage accounts for assigned groups and coordinate with internal departments.
• Oversee daily administration of provider relationships, ensure accurate and current provider databases, and provide training to providers.
• Research and resolve complex issues related to contract loading, financial responsibility interpretation, and provider data issues.
• Serve as primary point of contact between providers and the health plan.
• Provide issue resolution support for complex provider contracts and data issues.

Skills

Provider services experience (5+ years

Provider contracting

Managed care knowledge

Data interpretation

Education

Bachelor's degree in healthcare related field or equivalent experience

Job description

Centene Corporation is seeking a Provider Relations Specialist to ensure accurate provider setup in the information system for state reporting and claims processing. The role involves coordinating with providers, internal departments, and external representatives to resolve data issues and maintain current provider databases.

Requirements include a healthcare-related bachelor's degree or equivalent experience and 5+ years in provider services within a managed care environment, including