Provider Engagement Network Specialist

April 16

☕ Washington – Remote

Although this job is listed in Washington, this company may be open to hiring remote in other states.

💵 $22 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🛜 Network Engineer

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Centene Corporation

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Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

Contracting • Network Development • Managed Care

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 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. • Performs other duties as assigned. • Complies with all policies and standards.

🎯 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