Senior Provider Engagement Network Specialist

Coordinated Care; New Mexico; Remote; USD 55,000 - 99,000; Full time

Job summary

A leading healthcare company is seeking a Senior Provider Engagement Network Specialist to manage provider relationships and ensure accurate data setup. This role involves resolving complex provider contract issues and supporting provider representatives. The ideal candidate will have extensive experience in provider services and healthcare operations, along with strong analytical skills. Comprehensive benefits and flexible work arrangements are offered.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Holidays

Flexible Work Arrangements

Qualifications

• 5+ years of provider services experience including managed healthcare.
• Familiarity with claims/provider data platforms preferred.

Responsibilities

• Ensure providers are accurately set up in the provider information system.
• Act as internal and external liaison for provider networking.
• Manage daily administration of contractual provider relationships.

Skills

Analytical Skills

Reporting Skills

Education

Bachelor's degree in a healthcare-related field

Tools

Xcelys

Amisys

Job description

Senior Provider Engagement Network Specialist

Join to apply for the Senior Provider Engagement Network Specialist role at Coordinated Care.

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.

• Act as the internal and external liaison for provider networking, maintaining positive relationships with physicians, physician groups, multi-specialty groups, and ancillary providers within the assigned area.
• Serve as account manager for assigned groups, acting as gatekeeper for interactions with internal departments.
• Manage daily administration of contractual provider relationships, oversee provider databases, and provide training and education to providers.
• Research, analyze, and resolve complex issues related to contract loading, financial responsibilities, contract language, appeals, grievances, and eligibility.
• Serve as primary contact and liaison between providers and the health plan.
• Support issue resolution for complex provider contracts, researching and partnering to resolve claims and data issues.
• Act as subject matter expert in the department.
• Perform other duties as assigned and ensure compliance with policies and standards.

Qualifications: Bachelor's degree in a healthcare-related field or equivalent experience. 5+ years of provider services experience, including managed healthcare, provider contracting, benefits interpretation, and provider relations operations. Familiarity with Centene's claims/provider data platforms (e.g., Xcelys, Amisys), and proficiency in data review and root cause analysis are preferred. Analytical and reporting skills related to internal operations and claims are valuable.

Compensation and Benefits: Pay range $55,100 - $99,000 per year. Comprehensive benefits include health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements (remote, hybrid, field, or office).

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 Details:

• Seniority level: Not Applicable
• Employment type: Full-time
• Job function: Information Technology
• Industries: Hospitals, Healthcare, and Insurance

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