Senior Provider Engagement Network Specialist

Fidelis Care - New Jersey; New Jersey; On-site; USD 56,000 - 101,000; Full time

Job summary

Fidelis Care - New Jersey seeks a Provider Services professional to ensure accurate provider setup in the information system for state reporting, claims payment, and directories. You will support provider representatives and resolve data issues, serving as a liaison for networks within New Jersey.

The role requires a healthcare-related bachelor's degree and 5+ years in provider services within managed care.

Qualifications

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

Responsibilities

• Act as liaison for provider networking and maintain positive relationships with providers and groups.
• Serve as account manager for assigned groups and gatekeeper for internal department interactions.
• Administer and operate contractual provider relationships with accurate databases and training for providers.
• Research, analyze and resolve complex problems in contract loading, financial responsibility interpretation, and contract language.
• Serve as primary point of contact between providers and the health plan.
• Provide issue resolution support for provider contracts by researching and partnering to resolve data issues.
• Act as department subject matter expert.
• Performs other duties as assigned and comply with policies and standards.

Skills

Provider relations

Account management

Data troubleshooting

Contract interpretation

Training providers

Education

Bachelor’s degree in healthcare related field

Job description

This position covers the state of NJ and requires the candidate to reside in that state.

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:

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

• 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: $56,200.00 - $101,000.00 per year

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.

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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