Senior Provider Engagement Network Specialist

Centene Management Company LLC; Pennsylvania; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

PTO + holidays

Flexible work arrangements

Job summary

Centene Management Company LLC in Pennsylvania seeks a Provider Data Specialist to perform day-to-day duties ensuring providers are accurately set up in the provider information system for state reporting, claims payment, and directories. The role requires 5+ years in provider services and a healthcare-related bachelor's degree, with remote work and occasional travel.

You will serve as liaison with physicians and provider groups, manage provider databases, resolve data issues, and support

Qualifications

• Bachelor’s degree in healthcare related field or equivalent experience.
• 5+ years of provider services experience in a managed health care environment.
• Residence in Western/Southwestern Pennsylvania; remote role with occasional travel.

Responsibilities

• Act as internal and external liaison for provider networking and maintain relationships with physicians, PPGs, and ancillary providers.
• Serve as account manager for assigned groups as gatekeeper for interactions with other departments.
• Oversee daily administration and operation of provider relationships, including accurate and current provider databases, training and information for providers.
• Research, analyze and resolve complex problems related to contract loading, financial responsibility interpretation, contract rate and language interpretation, appeals and eligibility.
• Serve as primary contact between providers and the health plan; provide issue resolution for provider data and claims.

Skills

Provider relations

Account management

Data administration

Issue resolution

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: 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.

Candidates must be in Western/Southwestern Pennsylvania to be considered for this position. This is a remote role that requires occasional travel for meetings.

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.

• 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.

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.

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.