Provider Relations Specialist I
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 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
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. Driver's License may be required by some plans. Specific language skills may be required by some plans.
License/Certification: Valid 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.
Business Development & Sales
Peach State Health Plan
Location/Region: Atlanta, GA