Senior Provider Engagement Network Specialist

Oklahoma Complete Health; Hyde Park Township (IL); Remote; USD 55,000 - 99,000; Full time

Job summary

A leading health organization is seeking a Senior Provider Engagement Network Specialist to manage provider relationships and ensure accurate data in the provider information system. The role involves supporting external provider representatives, resolving complex issues, and maintaining positive relationships with healthcare providers. Ideal candidates will have a bachelor's degree in a healthcare field and significant experience in provider services within a managed care environment. This position offers competitive pay and a flexible work approach.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 5+ years of provider services experience required.
• Experience in managed health care environment.

Responsibilities

• Maintain provider information system for state reporting and claims payment.
• Act as liaison for provider networking and manage contractual relationships.

Skills

Analytical

Problem Solving

Communication

Education

Bachelor’s degree in healthcare related field

Tools

Xcelys

Amisys

Job description

Senior Provider Engagement Network Specialist page is loaded

Senior Provider Engagement Network Specialist

Apply locations Remote-WA Remote-MT Remote-NM Remote-AZ Remote-MI time type Full time posted on Posted Yesterday job requisition id 1571100

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.

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.

• 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.

This position will require the ability to support and partner with provider facing teams, as well as experience in Operations. The ideal candidate is familiar with Centene's claims/provider data platforms (including Xcelys and Amisys), and can perform advanced functions in review and root cause analysis of provider issues. Analytical and reporting experience, related to internal operations and claims, is valuable for this position.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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. Total compensation may also include additional forms of incentives.

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.

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

Similar Jobs (5)

Director, Strategic Provider Partnerships

locations Remote-HI time type Full time posted on Posted 14 Days Ago

Provider Engagement Account Manager

locations Remote-HI time type Full time posted on Posted 18 Days Ago

Provider Engagement Account Manager

locations 2 Locations time type Full time posted on Posted 6 Days Ago