Senior Provider Engagement Network Specialist

Centene Corporation

1d•Hybrid

About The Position

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, due to travel requirements, we are seeking candidates who live in Reno/Sparks – Washoe County, Nevada. Position Purpose: Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to resolve provider data issues. Research and effectively respond to provider related issues. Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG’s), multi-specialty groups, and/or 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.

Requirements

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

Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories.
Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up.
Provide support to external provider representatives to resolve provider data issues.
Research and effectively respond to provider related issues.
Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG’s), multi-specialty groups, and/or 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