Senior Provider Network & Data Liaison (Remote)

Centene Corp.; East Pittsburgh (Allegheny County); Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/office work options

Job summary

Centene is seeking a Provider Services professional to ensure providers are correctly set up in the provider information system for state reporting, claims payment, and directories. You will manage provider databases, train providers, and resolve complex contracting and data issues from a Western/Southwestern Pennsylvania base with occasional travel.

The role requires a Bachelor's in a healthcare field or equivalent experience 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 care environment with exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations.

Responsibilities

• 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

Bachelor’s degree in healthcare related field

Job description

Centene is seeking a Provider Services professional to ensure providers are correctly set up in the provider information system for state reporting, claims payment, and directories. You will manage provider databases, train providers, and resolve complex contracting and data issues from a Western/Southwestern Pennsylvania base with occasional travel.

The role requires a Bachelor's in a healthcare field or equivalent experience and 5+ years in provider services within managed care.