Senior Provider Engagement Network Specialist

Centene Corporation•Remote-FL, FL

2d•$56,200 - $101,000

About The Position

Perform day-to-day duties to ensure providers are accurately set up 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 issues. The specialist serves as an internal and external liaison for provider networking, maintaining relationships with participating physicians, physician groups, multi-specialty groups, and ancillary providers in an assigned area. The role acts as account manager for assigned groups and as their gatekeeper for interactions with other internal departments. It administers contractual provider relationships, maintains accurate and current provider databases, and provides provider training, education, and information. The specialist is the primary point of contact between assigned providers and the health plan, supports resolution of complex provider contract, claims, and data issues, and serves as a department subject matter expert. The position requires authorization to work in the U.S. without current or future employment-based visa sponsorship. Sponsorship is not available for the visa types listed in the posting. Other duties may be assigned, and the employee must comply with all policies and standards.

Requirements

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

Responsibilities

Ensure providers are accurately set up in the provider information system for state reporting, claims payment, and directories.
Manage state deliverables, network reporting, directories, and claims payment resolution related to provider setup.
Support external provider representatives in resolving provider data issues; research and respond to provider-related issues.
Act as an internal and external liaison for provider networking and maintain positive relationships with participating physicians, physician groups, multi-specialty groups, and ancillary providers in the assigned area.
Act as account manager for assigned groups and gatekeep their interactions with other internal departments.
Administer contractual provider relationships, oversee accurate and current provider databases, and provide training, education, and information to providers.
Research, analyze, and resolve complex issues involving contract loading, division of financial responsibility interpretation, contract rate and language interpretation, 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 provider claims and data issues involving the most complex provider contracts.
Act as a department subject matter expert.
Perform other duties as assigned and comply with all policies and standards.