Senior Provider Engagement Network Specialist

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟠 Senior

🛜 Network Engineer / Network Administrator

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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.

📋 Description

• Assure providers are set up accurately in the provider information system for state reporting, claims payment, and directories • Manage multiple 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 effectively to provider-related issues • Act as internal and external liaison for provider networking • Maintain working relationships with participating physicians, physician groups, multi-specialty groups, and ancillary providers • Act as account manager and gatekeeper for assigned provider groups • Administer and operate contractual provider relationships • Oversee accurate and current provider databases • Provide training, education, and information to providers • Research, analyze, and resolve complex problems involving contract loading, financial responsibility interpretation, contract rate and language interpretation, appeals, grievances, and eligibility • Serve as primary point of contact between assigned providers and the health plan • Resolve complex provider contract, claims, and data issues • Act as department subject matter expert • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor’s degree in healthcare related field or equivalent experience required • 5+ years of provider services experience required • Experience in a managed health care environment • Exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations • Experience with provider information systems, provider databases, state reporting, claims payment, directories, contract loading, financial responsibility interpretation, contract rates and language, appeals, grievances, and eligibility

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity