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Provider Network Specialist I

Philadelphia, Pennsylvania Apply Now Job ID 1151816 Category Network Development & Contracting Organization Pennsylvania Health and Wellness Schedule Full-time
Description:

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 in state between Philadelphia County and Buck County

Qualifications:


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.


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.

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