Senior Provider Network Engagement Lead (Remote/Hybrid)

Centene Corp.; Ohio; Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. in Ohio is seeking a Provider Services lead to ensure accurate provider setup and ongoing administration for state reporting, claims payment, and directories.

You will resolve complex provider data issues, support external provider representatives, and collaborate with internal departments. Qualified candidates have a Bachelor’s degree in healthcare and at least 5 years of provider services experience in managed care, with strong contract interpretation and data management skills.

Qualifications

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

Responsibilities

• Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, PPGs, multi-specialty groups, and 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

Skills

Provider relations

Contract interpretation

Claims resolution

Liaison / stakeholder management

Data analysis

Training & education

Communication

Education

Bachelor’s degree in healthcare

Job description

Centene Corp. in Ohio is seeking a Provider Services lead to ensure accurate provider setup and ongoing administration for state reporting, claims payment, and directories.

You will resolve complex provider data issues, support external provider representatives, and collaborate with internal departments. Qualified candidates have a Bachelor’s degree in healthcare and at least 5 years of provider services experience in managed care, with strong contract interpretation and data management skills.