Senior Provider Network Engagement Lead (Remote)

Centene Management Company LLC; Florida; 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 and holidays

Flexible work options (remote/hybrid/“

Job summary

Centene Management Company LLC is seeking a dedicated professional to manage provider data setup and state reporting across multiple programs. The role focuses on accurate provider records, claims payment support, and directory maintenance while coordinating with external provider representatives to resolve data issues.

The ideal candidate will have a healthcare background and substantial provider services experience in a managed care environment, including contracting, benefits interpretation,

Qualifications

• 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.

Responsibilities

• Act as internal and external liaison for provider networking, maintaining positive working 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 other internal departments.
• Oversee daily administration and operation of contractual provider relationships, including provider databases, training, and information sharing with providers.
• Research, analyze and resolve complex problems involving contract loading, financial responsibility interpretation, contract language interpretation, appeals, grievances and eligibility.
• Provide issue resolution support for provider contracts by researching and partnering to resolve provider claims and data issues.

Job description

Centene Management Company LLC is seeking a dedicated professional to manage provider data setup and state reporting across multiple programs. The role focuses on accurate provider records, claims payment support, and directory maintenance while coordinating with external provider representatives to resolve data issues.

The ideal candidate will have a healthcare background and substantial provider services experience in a managed care environment, including contracting, benefits interpretation,