Remote Senior Provider Network & Relations Specialist

Centene Corp.; Oregon; Ibrido; USD 56.000 - 101.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Descrizione del lavoro

Centene Corporation is seeking a Provider Relations Specialist to ensure accurate provider data in the provider information system used for state reporting, claims payment, and directories. You will liaise with physicians, groups, and ancillary providers within the assigned area and coordinate with internal departments.

This remote role requires a healthcare-related bachelor’s degree and 5+ years in provider services; occasional travel for meetings is expected.

Competenze

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

Mansioni

• Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG's), multi-specialty groups, and/or ancillary providers within assigned area.
• Act as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.
• Responsible for daily administration and operation of the contractual provider relationships, including overseeing accurate and current provider databases, providing training, education and information to providers.
• Research, analyze and resolve complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
• Serve as primary point of contact and liaison between assigned providers and the health plan.
• Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues.
• Act as department subject matter expert.
• Performs other duties as assigned
• Complies with all policies and standards

Conoscenze

Provider relations

Contract loading

Data interpretation

Issue resolution

Formazione

Bachelor's degree in healthcare related field

Descrizione del lavoro

Centene Corporation is seeking a Provider Relations Specialist to ensure accurate provider data in the provider information system used for state reporting, claims payment, and directories. You will liaise with physicians, groups, and ancillary providers within the assigned area and coordinate with internal departments.

This remote role requires a healthcare-related bachelor’s degree and 5+ years in provider services; occasional travel for meetings is expected.