You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
- Receive and effectively respond to external provider related issues
- Provide education on health plan’s innovative contracting strategies
- Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
- Investigate, resolve and communicate provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
- Ability to travel
Our Comprehensive Benefits Package:
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plans
- Tuition reimbursement and best-in-class training and development
- Bachelor’s degree in related field or equivalent experience.
- 0-2 years of provider relations or contracting experience.
- Knowledge of health care, managed care, Medicare or Medicaid.
- Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Clipped from: https://jobs.centene.com/us/en/job/1296454/Provider-Network-Specialist-I?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic