Senior Provider Engagement Network Specialist

Centene Corporation; Columbus (OH); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Job summary

Centene Corporation in Ohio seeks a Provider Relations Specialist to ensure accurate provider setup in the information system, support state reporting and claims payment, and maintain current directories.

You will serve as a liaison between providers and internal departments, manage provider relationships, and provide training and guidance to providers. A healthcare degree and 5+ years of provider services experience are required.

Qualifications

• Bachelor’s degree in healthcare-related field; 5+ years in provider services within a managed care environment.

Responsibilities

• Ensure providers are correctly set up in the provider information system for state reporting and claims payment.
• Serve as primary liaison for provider networking and coordination with internal departments.
• Manage daily administration of provider relationships and maintain current provider databases.
• Train and educate providers with information and guidance.
• Research and resolve complex provider data and contract issues.
• Act as department subject matter expert and support external provider representatives.
• Comply with policies and standards.

Skills

Provider relations

Liaison / communication

Training and education

Problem solving

Account management

Subject matter expert

Education

Bachelor’s degree in healthcare related field

Job description

Position Purpose

Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to resolve provider data issues. Research and effectively respond to provider related issues.

Key details : Candidates must live in Ohio.

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

Education/Experience

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.

Pay Range

Pay Range: $56,200.00 - $101,000.00 per year

About Centene

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.

You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.

Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Other

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act