Provider Engagement Network Specialist

6 days ago

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Centene Corporation

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Contracting • Network Development • Managed Care

10,000+

Description

• 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. • Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up. • Provide support to the external provider representative to resolve provider data issues. • Research and effectively respond to provider related issues. • Submit provider data entries to resolve provider-related demographic information changes. • Initiate and process provider add, change and termination forms. • Create and maintain spreadsheets used to produce provider directories for multiple products. • Track, update and audit provider data. • Identify adds, deletes and updates to key provider groups and model contract. • Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment. • Provide assistance to providers with website registration. • Facilitate provider education via webinar. • Work with other departments on cross functional tasks and projects. • Facilitate new provider orientations. • Facilitate provider trainings.

Requirements

• Associate's degree and claims processing, billing and/or coding experience preferred • Three years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims • Knowledge of health care, managed care, Medicare or Medicaid

Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules