Provider Data Management Specialist I

Centene Corporation

3d•$19 - $33

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. NOTE: For this role we are seeeking candidates who live in the Eastern or Central Standard Time zone Position Purpose: Maintain accurate databases and reports to monitor network compliance with State requirements Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections Oversee the provider termination process including adding and changing new or existing provider records in the medical information system Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution Perform general administrative tasks in support of assigned department Performs other duties as assigned. Complies with all policies and standards.

Requirements

High school diploma or equivalent.
2+ years of provider data or network administration experience, preferably in a managed care setting.

Nice To Haves

Associate’s degree in health care or a related field preferred.

Responsibilities

Maintain accurate databases and reports to monitor network compliance with State requirements
Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections
Oversee the provider termination process including adding and changing new or existing provider records in the medical information system
Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes
Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance
Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
Perform general administrative tasks in support of assigned department
Performs other duties as assigned.
Complies with all policies and standards.