Senior Provider Engagement Network Specialist

Centene Corporation•Pittsburgh, PA

7d•$56,200 - $101,000•Remote

About The Position

Perform day-to-day duties to ensure providers are set up accurately in the provider information system for state reporting, claims payment, and directories. The role is responsible for multiple state deliverables, network reporting and directories, and resolving claims payment issues related to provider setup. It also supports external provider representatives with provider data issues and researches and responds to provider-related concerns. The specialist acts as an internal and external liaison for provider networking and manages assigned provider relationships, serving as the primary point of contact between those providers and the health plan. The role administers contractual provider relationships, maintains provider databases, provides provider training and information, and researches and resolves complex contract, claims, data, and other provider issues. The position is remote and requires occasional travel for meetings. Candidates must be located in Western or Southwestern Pennsylvania and must be authorized to work in the U.S. without current or future employment-based visa sponsorship.

Requirements

Bachelor’s degree in a healthcare-related field or equivalent experience.
At least 5 years of provider services experience.
Experience in a managed healthcare environment, including exposure to provider contracting, benefits interpretation, and the internal operations of provider relations.
Must be located in Western or Southwestern Pennsylvania.
Must be authorized to work in the U.S. without the need for current or future employment-based visa sponsorship.

Responsibilities

Maintain positive working relationships with participating physicians, physician groups, multispecialty groups, and ancillary providers in the assigned area.
Act as account manager and gatekeeper for assigned groups’ interactions with other internal departments.
Administer and operate contractual provider relationships, including overseeing accurate and current provider databases and providing provider training, education, and information.
Research, analyze, and resolve complex issues involving contract loading, division of financial responsibility, contract rates and language, appeals, grievances, and eligibility.
Serve as the primary point of contact and liaison between assigned providers and the health plan.
Research and partner with others to resolve claims and data issues for complex provider contracts.
Serve as the department subject matter expert.
Perform other duties as assigned.
Comply with all policies and standards.