Provider Relations Specialist I
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 onsite 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
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.
License/Certification:
Valid 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.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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 onsite 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
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.
License/Certification:
Valid 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.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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