Senior Provider Engagement Network Specialist

Centene Corporation•Remote-OH, OH

12d•$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 concerns. The specialist acts as an internal and external liaison for provider networking and maintains positive working relationships with participating physicians, physician groups, multispecialty groups, and ancillary providers in an assigned area. As account manager for assigned groups, the specialist serves as a gatekeeper for interactions with other internal departments and is the primary point of contact between assigned providers and the health plan. The role administers contractual provider relationships, oversees accurate and current provider databases, and provides training, education, and information to providers. It researches, analyzes, and resolves complex issues involving contract loading, division of financial responsibility, contract rates and language, appeals, grievances, and eligibility. The specialist supports resolution of complex provider contract, claims, and data issues and acts as a department subject matter expert. Candidates must live in Ohio.

Requirements

Must live in Ohio.
Bachelor’s degree in a healthcare-related field or equivalent experience required.
At least 5 years of provider services experience required.
Experience in a managed health care environment, including exposure to provider contracting, servicing benefits interpretation, and the internal operations of provider relations.

Responsibilities

Ensure providers are accurately set up in the provider information system for state reporting, claims payment, and directories.
Support multiple state deliverables, network reporting, directories, and claims payment resolution related to provider setup.
Provide support to external provider representatives to resolve provider data issues; research and respond effectively to provider-related issues.
Act as an internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, physician groups, multispecialty groups, and ancillary providers in the assigned area.
Manage assigned groups as account manager and serve as 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 for the most complex provider contracts.
Act as the department subject matter expert.
Perform other duties as assigned.
Comply with all policies and standards.