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Provider Relation Specialist I

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This job is available in 2 locations

Provider Relation Specialist I

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Description

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.

***We are seeking candidates who live in or near Lincoln, NE with dental experience***

Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.

  • Serve as primary contact for providers serving as a liaison between the provider and the health plan
  • Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution
  • Receive and respond to external provider related issues
  • Initiate entry or change of provider related database information and oversee testing and completion of change request
  • Investigate, resolve and communicate provider claim issues and changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
  • Perform provider orientations, including writing and updating orientation materials
  • Ability to travel, up to 20% per month
  • Performs other duties as assigned
  • Complies with all policies and standards
Education/Experience: High school diploma or equivalent. Bachelor’s degree in healthcare related field preferred. 3+ years of sales, provider relations, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Claims billing/coding knowledge preferred. Driver’s License may be required by some plans. Specific language skills may be required by some plans.

License/Certification: Valid driver's license.Pay Range: $21.93 - $37.30 per hour

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.

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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