Job Description

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claims

• Conduct virtual and/or on-site provider visits and orientations, including writing and updating orientation materials and assisting providers acclimated to plan website
• Experience in claims, coding, billing preferred
• Monitor financial performance of contracts
• Investigate and document provider changes and correspondence
• Coordinate with credentialing to ensure all appropriate documentation is received
• Serve as a lead for key special projects
• Recommend changes in pricing subsystems
• Participate in the review of provider directories with corporate and plan level entities
• Investigate and respond to complex provider related issues and initiate change of provider related database information
• Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff
• Ability to travel up to 2x per year to meet with providers on site

Qualifications

Education/Experience: High school diploma or equivalent. Bachelor’s degree in healthcare related field preferred. 5+ years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver’s License may be required by some plans. Specific language skills may be required by some plans. For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.

The salary range for NY is: $51,600 - $92,900

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

Additional Information

All your information will be kept confidential according to EEO guidelines.