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Provider Relations Specialist I

Company: Centene Corporation
Location: Las Vegas
Posted on: June 12, 2021

Job Description:

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 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

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.

Keywords: Centene Corporation, Las Vegas , Provider Relations Specialist I, Other , Las Vegas, Nevada

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