Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claims.
High school diploma or equivalent. 5+ years of sales, provider relations, or contracting experience. Bachelor’s degree in healthcare related field preferred. Claims processing and/or managed care experience preferred.
Licenses/Certifications: Current state driver’s license.
• Conduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website
• Monitor financial performance of contracts
• Investigate and document provider changes and correspondence
• Coordinate with credentialing to ensure all appropriate documentation is received
• Serve as a lead for key special projects
• Recommend changes in pricing subsystems
• Coordinate printing of provider directories with corporate and plan level entities
• Investigate and respond to complex provider related issues and initiate change of provider related database information
• Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff
• Ability to travel
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...