Senior Provider Relations & Network Specialist (Remote)

Centene Corp.; Florida; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corp. in Remote-FL is seeking a Senior Provider Engagement Network Specialist to manage provider data, contracts, and relationships across state networks.

You will ensure accurate provider information for state reporting, claims, and directories, and act as liaison between providers and the health plan. The role requires a Bachelor’s degree in a healthcare-related field and 5+ years in provider services within a managed care environment, with experience in contracting, benefits

Qualifications

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

Responsibilities

• Serve as internal and external liaison for provider networking and maintain positive relationships with physicians, groups, and ancillary providers.
• Act as account manager for assigned groups as gatekeeper for interactions with other internal departments.
• Oversee daily administration and operation of contractual provider relationships, including provider databases, training, and information for providers.
• Research, analyze and resolve complex problems dealing with contract loading, financial responsibility interpretation, rate language, appeals, grievances and eligibility.
• Serve as primary contact between providers and the health plan and provide issue resolution for complex provider contracts.
• Act as department subject matter expert and perform other duties as assigned.

Skills

Provider services experience

Managed health care environment

Provider contracting

Benefits interpretation

Internal operations of provider_rel

Education

Bachelor's degree in healthcare related field

Job description

Centene Corp. in Remote-FL is seeking a Senior Provider Engagement Network Specialist to manage provider data, contracts, and relationships across state networks.

You will ensure accurate provider information for state reporting, claims, and directories, and act as liaison between providers and the health plan. The role requires a Bachelor’s degree in a healthcare-related field and 5+ years in provider services within a managed care environment, with experience in contracting, benefits