Senior Provider Engagement Network Specialist

Centene Management Company•Pittsburgh, PA

5d•Remote

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 by researching and responding to provider-related issues. Act as the internal and external liaison for provider networking and maintain positive working relationships with participating physicians, physician groups, multispecialty groups, and ancillary providers in the assigned area. Serve as the account manager and primary point of contact for assigned groups and providers, including acting as a gatekeeper for 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 rates and language, appeals, grievances, and eligibility. Provide issue-resolution support for the most complex provider contracts by researching and partnering with others to resolve provider claims and data issues. Act as a department subject matter expert, perform other duties as assigned, and comply with all policies and standards. This is a remote role for candidates located in Western or Southwestern Pennsylvania, with occasional travel for meetings. Applicants 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 health care environment, including exposure to provider contracting, servicing benefits interpretation, and internal provider relations operations.
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

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 by researching and resolving provider data issues.
Act as an internal and external liaison for provider networking and maintain positive relationships with participating physicians, physician groups, multispecialty groups, and ancillary providers in the assigned area.
Manage assigned provider groups and serve as a gatekeeper for interactions with other internal departments.
Administer contractual provider relationships and oversee accurate, current provider databases.
Provide training, education, and information to providers.
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 provider claims and data issues, including 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.