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Centene Corporation Provider Relations Specialist I in Indianapolis, Indiana

Professional Position Purpose: Perform duties to 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.

  • Serve as primary contact for providers serving as a liaison between the provider and the health plan

  • 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

  • Recommend changes in pricing subsystems

  • Author change requests and oversee through testing and completion.

  • Investigate and communicate provider changes

  • Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI solicitation and problem solving (liaison responsibilities)

  • Perform Provider orientations (includes writing/updating orientation material when necessary)

  • Must have a good driving record and the ability to travel

Education/Experience:

  • High school diploma or equivalent.

  • 3+ years of sales, provider relations, or contracting experience.

  • Knowledge of health care, managed care, Medicare or Medicaid.

  • Bachelor’s degree in healthcare related field preferred.

  • Claims billing/coding knowledge preferred.Licenses/Certifications: Current state driver’s license. 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.

TITLE: Provider Relations Specialist I

LOCATION: Indianapolis, Indiana

REQNUMBER: 1178410

COMPANY: Business Development & Sales

POSITION TYPE: Professional

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