Senior Provider Engagement Network Specialist

Oklahoma Complete Health; Alabama; Remote; USD 55,000 - 99,000; Full time

Job summary

A leading healthcare organization is seeking a Senior Provider Engagement Network Specialist to manage provider relationships and ensure accurate provider data. This role involves resolving complex issues and supporting providers within a managed healthcare environment. The position offers competitive pay and comprehensive benefits, including flexible work schedules.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Minimum of 5 years of provider services experience in managed healthcare.

Responsibilities

• Act as the liaison for provider networking and maintain relationships.
• Oversee daily administration and operation of contractual provider relationships.
• Research and resolve complex issues related to contracts and claims.

Skills

Provider Services

Project Management

Public Speaking

Education

Bachelor’s degree in a healthcare-related field

Job description

Senior Provider Engagement Network Specialist

Apply locations: Remote-MS, Remote-TN, Remote-LA, Remote-AL | Full time | Posted Yesterday | Job Requisition ID: 1565676

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits, including a fresh perspective on workplace flexibility.

Note: We are seeking candidates who reside in MS, TN, AL, or LA.

Position Purpose:

Perform daily duties to ensure providers are accurately set up in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting, directories, and claims payment resolution related to provider setup. Support external provider representatives in resolving provider data issues. Research and respond effectively to provider-related issues.

Key Responsibilities:

1. Act as the liaison for provider networking, maintaining positive relationships with participating physicians, physician groups (PPGs), multi-specialty groups, and ancillary providers within the assigned area.
2. Manage assigned groups as the account manager, acting as the gatekeeper for interactions with other internal departments.
3. Oversee daily administration and operation of contractual provider relationships, including maintaining accurate provider databases, and providing training and education to providers.
4. Research, analyze, and resolve complex issues related to contract loading, financial responsibility, contract rates and language, appeals, grievances, and eligibility.
5. Serve as the primary contact and liaison between assigned providers and the health plan.
6. Provide support for complex provider contracts by researching and partnering to resolve claims and data issues.
7. Act as a subject matter expert within the department.
8. Perform other duties as assigned and ensure compliance with all policies and standards.

Qualifications:

Bachelor’s degree in a healthcare-related field or equivalent experience. Minimum of 5 years of provider services experience, including in a managed healthcare environment with exposure to provider contracting, benefits interpretation, and provider relations operations. Hospital or physician office claims billing, project management, and public speaking experience are strongly preferred.

Pay Range: $55,100 - $99,000 annually.

Benefits:

Centene offers comprehensive benefits, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work schedules (remote, hybrid, field, or office). Actual compensation will be based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Equal Opportunity Employment:

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Additional Information:

Thank you for your interest in Centene. If you require accommodations during the application process, please email [e-mail].