Provider Relation Specialist I

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Job Overview

The Provider Relation Specialist I position with Centene Corporation offers an exciting opportunity to impact the lives of over 28 million members. Centene is dedicated to transforming the health of various communities through enhanced care, focusing on one individual at a time. This role is critical as it acts as a liaison between healthcare providers and the health plan, ensuring that all provider-related issues are investigated and resolved efficiently.

Position Purpose

The primary objective of this role is to serve as a direct point of contact for providers, addressing their needs and challenges while ensuring smooth communication between them and the health plan. Specific tasks include:

• Investigating and resolving provider claims issues.
• Performing training and orientation for physician practices to improve their performance.
• Conducting monthly face-to-face meetings with providers to document discussions, issues, attendees, and action plans.
• Responding promptly to external provider-related concerns, ensuring that their needs are met efficiently.

The successful candidate must also keep accurate records of database changes related to providers, oversee the testing of these changes, and communicate key policies and procedures around claims submission and referrals.

Required Skills

To thrive in this role, candidates should possess the following qualifications:

• A high school diploma or equivalent is essential; however, a Bachelor’s degree in a healthcare-related field is preferred.

• At least 3 years of experience in sales, provider relations, or contracting is required. Candidates should have knowledge of healthcare systems, including managed care, Medicare, or Medicaid.

• Familiarity with claims billing/coding is highly desirable.

• A valid driver’s license may be necessary for specific plans.

  

• Strong communication skills and the ability to travel when needed are also vital for this position.

Salary and Benefits

The pay range for this position is between $23.23 and $39.61 per hour. The actual salary will be influenced by the candidate's skills, experience, education, and other job-related factors. Additionally, employed individuals may benefit from a variety of options:

• Comprehensive benefits package, including health insurance and a 401K plan.

• Tuition reimbursement for continued education to support career growth.

• Generous paid time off and holiday benefits.

• Flexibility in work arrangements, which could include remote, hybrid, or office settings.

Work Environment

Candidates must be located within the Eastern Standard Time Zone to apply for this role. The work environment is remote, promoting workplace flexibility to accommodate various lifestyles while maintaining productivity.

Diversity Commitment

Centene Corporation is an equal opportunity employer, emphasizing a commitment to diversity and inclusion. The organization encourages applications from all qualified candidates, regardless of race, color, religion, gender identity, sexual orientation, disability, or veteran status. This commitment extends to ensuring that individuals with arrest or conviction records are considered in compliance with relevant laws.

Conclusion

The Provider Relation Specialist I role at Centene Corporation presents a unique opportunity for those looking to merge their skills in healthcare, relationship management, and service improvement. With a strong focus on enhancing patient care and achieving performance excellence, candidates ready to join a mission-driven organization will find this position highly rewarding.

This job offer was originally published on himalayas.app