Provider Relation Specialist I

Centene Corporation

1d•$23 - $40

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 seeking candidates who live within the Eastern Standard Time Zone Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Serve as primary contact for providers serving as a liaison between the provider and the health plan Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution Receive and respond to external provider related issues Initiate entry or change of provider related database information and oversee testing and completion of change request Investigate, resolve and communicate provider claim issues and changes Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving Perform provider orientations, including writing and updating orientation materials Ability to travel Performs other duties as assigned Complies with all policies and standards

Requirements

High school diploma or equivalent.
3+ years of sales, provider relations, or contracting experience.
Knowledge of health care, managed care, Medicare or Medicaid.
Driver’s License may be required by some plans.
Specific language skills may be required by some plans.
Valid driver's license.

Nice To Haves

Bachelor’s degree in healthcare related field preferred.
Claims billing/coding knowledge preferred.

Responsibilities

Act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues.
Perform training, orientation and coaching for performance improvement within physician practices.
Serve as primary contact for providers serving as a liaison between the provider and the health plan
Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution
Receive and respond to external provider related issues
Initiate entry or change of provider related database information and oversee testing and completion of change request
Investigate, resolve and communicate provider claim issues and changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
Perform provider orientations, including writing and updating orientation materials
Ability to travel
Performs other duties as assigned
Complies with all policies and standards

Benefits

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
Total compensation may also include additional forms of incentives.
Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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