Centene Corporation LTSS Provider Network Specialist I in Harrisburg, Pennsylvania
ProfessionalPosition 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
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.
For South Carolina only - Current state driver's license preferred.
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.
TITLE: LTSS Provider Network Specialist I
LOCATION: Harrisburg, Pennsylvania
COMPANY: Network Development & Contracting
POSITION TYPE: Professional