Provider Network Support Specialist I
Company: Careerbuilder-US
Location: Hialeah
Posted on: January 16, 2023
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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: Perform day to day duties of assuring that
providers (individual, group, ancillary, etc.) are set up
accurately in the provider information system for state reporting,
claims payment, and directories. Responsible for multiple state
deliverables, network reporting and directories as well as claims
payment resolution as it relates to provider set up.--- -Provide
support to the external provider representative to resolve provider
data issues--- - - -Research and effectively respond to provider
related issues--- - - -Submit provider data entries to resolve
provider-related demographic information changes--- - - -Initiate
and process provider add, change and termination forms--- - -
-Create and maintain spreadsheets used to produce provider
directories for multiple products.--- - - -Track, update and audit
provider data--- - - -Identify adds, deletes and updates to key
provider groups and model contracts--- - - -Research and identify
any processing inaccuracies in claim payments and route to the
appropriate site operations team for claim adjustment--- - -
-Provide assistance to providers with website registration--- - -
-Facilitate provider education via webinar--- - - -Work with other
departments on cross functional tasks and projects--- - -
-Facilitate new provider orientations--- - - -Facilitate provider
trainings--- - - -Completes special projects as
assignedEducation/Experience: Associates degree and claims
processing, billing and/or coding experience preferred. Three years
of experience in managed care environment, medical provider office,
customer service within a healthcare organization, and medical
claims. Knowledge of health care, managed care, Medicare or
Medicaid. Intermediate Demonstrated interpersonal/verbal
communication skills, Intermediate Demonstrated written
communication skills, Intermediate Demonstrated organizational
skills, Intermediate Demonstrated time management and priority
setting skills, Intermediate Demonstrated customer service skills,
Intermediate Ability to represent the company with internal
constituents, Intermediate Ability to work independently,
Intermediate Ability to multi-task, Intermediate Demonstrated
problem solving skills, Intermediate Demonstrated analytical
skills. Required, Intermediate Microsoft Excel, Intermediate
Microsoft Outlook and Intermediate Microsoft Word.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.
Keywords: Careerbuilder-US, Hialeah , Provider Network Support Specialist I, Other , Hialeah, Florida
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