Centene believes quality healthcare is best delivered locally.
Our local approach enables us to provide our members with
high-quality and culturally sensitive healthcare services, and our
hiring practices reflect the composition of the members and
communities we serve.
This is a field-base position, as you will be meeting with our
Providers (once it is safe to do so). Qualified applicants must be
willing to be field based and cover the southern Nevada area,
between Henderson and Las Vegas.
As a Provider Relations Specialist, you will be the face of our
health plan. You will 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.
Additional responsibilities include, but not limited to:
- 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
- Investigate, resolve and communicate provider claim issues and
- 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
- Ability to travel
Highly Qualified Individuals Will Have The Following:
- Previous experience in a Provider facing role
- At least 1 year of claims and billing experience
- Contracting experience
- Knowledge with FFS Medicaid requirements
- Excellent communication skills, both written and verbal
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.
Key Words: Provider Relations, Provider Network, Provider
Liaison, Network Coordinator, Network Representative, STARS,
Provider Groups, Reimbursement, Analyst, Provider Education,
Educate, Healthcare, Engagement, Manager, Claims
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.