Hotline: 678-408-1354

Provider Network Specialist I

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

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.

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.

Contact Us

Eltas EnterPrises Inc.
3978 Windgrove Crossing
Suite 200A
Suwanee, Georgia
30024, USA
contact@eltasjobs.com

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