Senior Provider Relations & Data Specialist (Remote)

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work with remote/hybrid/field

Job summary

Centene Corp. is seeking a Provider Relations professional in Western/Southwestern Pennsylvania for a remote role with occasional travel. You will ensure accurate provider setup, manage provider databases, and resolve data issues related to state reporting, claims payment, and directories.

Requires a bachelor's in healthcare and 5+ years in provider services. The role oversees provider relationships, contracts, and benefits interpretation within a managed care environment, with travel as needed.

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 participating physicians, physician groups, multi-specialty groups, and ancillary providers.
• 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 ensuring 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 contracting

Benefits interpretation

Provider relations operations

Data analysis

Communication with providers

Education

Bachelor’s degree in healthcare related field

Job description

Centene Corp. is seeking a Provider Relations professional in Western/Southwestern Pennsylvania for a remote role with occasional travel. You will ensure accurate provider setup, manage provider databases, and resolve data issues related to state reporting, claims payment, and directories.

Requires a bachelor's in healthcare and 5+ years in provider services. The role oversees provider relationships, contracts, and benefits interpretation within a managed care environment, with travel as needed.