Provider Network Specialist I

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose : Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan
• Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
• Receive and effectively respond to external provider related issues
• Provide education on health plan’s innovative contracting strategies
• Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Ability to travel

Education / Experience : Bachelor’s degree in related field or equivalent experience. 0-2 years of provider relations or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare or a related field preferred. Claims billing / coding knowledge preferred.

Licenses / Certifications : Current state driver’s license.

Pay Range : $46,500.00 - $79,200.00 per year

Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.