Senior Provider Engagement Network Specialist

Centene Corporation•Remote-NJ, NJ

2d•$56,200 - $101,000•Hybrid

About The Position

This position covers the state of NJ and requires the candidate to reside in that state. The purpose of this role is to 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. The specialist will be responsible for multiple state deliverables, network reporting and directories, as well as claims payment resolution as it relates to provider set up. They will also provide support to external provider representatives to resolve provider data issues and research and effectively respond to provider-related issues. This role requires the candidate to be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Bachelor’s degree in healthcare related field or equivalent experience required.
5+ years of provider services experience required.
Experience in a managed health care environment.
Exposure to provider contracting.
Exposure to servicing benefits interpretation.
Exposure to internal operations of provider relations.
Must reside in NJ.

Responsibilities

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