Senior Provider Engagement Network Specialist

Centene Corporation • Jefferson City, MO • 17h ago

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.

NOTE: For this role, we are seeking candidates who live in Missouri

Position Purpose: 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 external provider representatives to resolve provider data issues. Research and effectively respond to provider related issues.

Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG's), multi-specialty groups, and/or ancillary providers within assigned area.

Act as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.

Responsible for daily administration and operation of the contractual provider relationships, including overseeing accurate and current provider databases, providing training, education and information to providers.

Research, analyze and resolve complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.

Serve as primary point of contact and liaison between assigned providers and the health plan.

Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues.

Act as department subject matter expert.

Performs other duties as assigned

Complies with all policies and standards

Education/Experience: Bachelor's degree in healthcare related field or equivalent experience required. 5+ years of provider services experience required, including experience in a managed health care environment with exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations.Pay Range: $56,200.00 - $101,000.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Similar Jobs

CDL-A - New pay increase - Team Van Truckload truck driver

Schneider • Fulton, MO • 1h ago

Trucking & Construction

New pay increase - Team Van Truckload truck driver Average pay: $1,340-$1,630 weekly Home time: Every three weeks Experience: All CDL holders Overview Dry van trailers with 100% no-touch freight. Drive within all 48 stat...

1h ago

Go to Apply

CDL-A - New pay increase - Team Van Truckload truck driver

Schneider • Jefferson City, MO • 1h ago

Trucking & Construction

1h ago

Go to Apply

Occupational Therapist (OT)

Phoenix Home Care and Hospice • Jefferson City, MO • 3h ago

Hospital & Medical

Now Hiring Home Health Occupational Therapist $5,000 Sign on Bonus! Jefferson City and Columbia, MO Full Time, Days Pay Range: $85,000 - $95,000 Ready for more flexibility and one on one patient care that actually makes...

3h ago

Go to Apply

Distinguished AI Engineer (Remote Eligible)

Capital One • Jefferson City, MO • 4h ago

IT & Engineering

Distinguished AI Engineer (Remote Eligible) At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to...

4h ago

Go to Apply

Software Development Engineer

CVS Health • Jefferson City, MO • 7h ago

IT & Engineering

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate...

7h ago

Go to Apply

(USA) Tire and Battery Service Advisor

Walmart • Jefferson City, MO • 11h ago

Management & Administrative

Position Summary... What you'll do... Maintains facility and sales floor safety and standards by adhering to all safety policies and procedures, including conducting regular safety sweeps, following proper forklift and h...

11h ago

Go to Apply

(USA) Freight Flow Associate

Walmart • Jefferson City, MO • 11h ago

Position Summary... What you'll do... Complies with company policies procedures and standards of ethics and integrity by implementing related action plans using the Open Door Policy: and applying these in executing busin...

11h ago

Go to Apply

Customer Service / Tech Support Rep - Financial (Remote)

Concentrix • Jefferson City, MO • 16h ago

Finance, Accounting & Banking

Join our award-winning "One Concentrix" team as a remote Customer Service / Tech Support Representative! We're looking for passionate game-changers to deliver exceptional customer experiences and solutions for one of the...

16h ago

Go to Apply

Oracle NetSuite Solution Consultant, Intelligent Analytics & AI

Oracle • Jefferson City, MO • 20h ago

Management & Administrative

Job Description Senior Solution Consultant, Intelligent Analytics & AI Who are we? At Oracle NetSuite, our vision is to transform how businesses operate so they can achieve their business goals faster, smarter, and w...

20h ago

Go to Apply

Associate Director - Growth Marketing

Wolters Kluwer • Jefferson City, MO • 1d ago

Sales & Marketing

Role Overview As Associate Director, Digital & Integrated Marketing for ELM, you will lead the strategy and execution of a full-funnel marketing engine designed to drive enterprise pipeline, new logo acquisition, and...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)