Senior Provider Engagement Network Specialist

🔥 7 minutes ago

🏈 Ohio – Remote

🏈 Ohio – 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

• Ensure providers are set up accurately in the provider information system for state reporting, claims payment, and directories • Manage multiple state deliverables, network reporting, and directories • Resolve claims payment issues related to provider setup • Support external provider representatives in resolving provider data issues • Research and respond to provider-related issues • Act as liaison for provider networking with physicians, physician groups, multi-specialty groups, and ancillary providers • Manage assigned provider groups and gatekeep interactions with internal departments • Administer contractual provider relationships and maintain accurate provider databases • Provide training, education, and information to providers • Research, analyze, and resolve complex contract, financial responsibility, rate, language, appeals, grievances, and eligibility issues • Serve as primary liaison between assigned providers and the health plan • Provide issue-resolution support for complex provider contracts, claims, and data issues • Act as department subject matter expert • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Candidates must live in Ohio • 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 • Exposure to servicing benefits interpretation • Exposure to internal operations of provider relations • Experience with contract loading • Experience interpreting division of financial responsibility • Experience interpreting contract rates and language • Experience handling appeals, grievances, and eligibility • Ability to research, analyze, and resolve complex provider contract, claims, and data issues

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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

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