Provider Network Support Specialist II

Centene Corporation•Remote-OK, MO

2d•$23 - $40•Remote

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. Position Purpose: Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) 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 the external provider representative to resolve provider data issues.

Requirements

Five + years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims
Knowledge of health care, managed care, Medicare or Medicaid

Nice To Haves

Associates degree
claims processing, billing and/or coding experience

Responsibilities

Research and effectively respond to provider related issues
Submit provider data entries to resolve provider-related demographic information changes
Initiate and process provider add, change and termination forms
Create and maintain spreadsheets used to produce provider directories for multiple products
Track, update and audit provider data
Identify adds, deletes and updates to key provider groups and model contracts
Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
Provide assistance to providers with website registration
Facilitate provider education via webinar
Work with other departments on cross functional tasks and projects
Facilitate new provider orientations
Facilitate provider trainings
Act as liaison for small PCP groups (as designated by departmental leadership)
Coaches new hires and less experienced Internal Reps
Completes special projects as assigned
Performs other duties as assigned
Complies with all policies and standards