Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider issues.
Perform new provider orientations and educate providers regarding the provider manual, and contract requirements. Serves as a resource for department staff and provides training as need.
Serve as contact for provider inquires and track inquiries and response times. Draft contracts and manage contracting process to verify that contract deadlines are met
Monitor provider credentialing activities and contact providers for missing or incomplete information
Maintain and update provider databases to include key provider demographics and specialty provider information
Conduct administrative audits of provider agencies to evaluate provider contract adherence
Review, audit and price contract related pends to verify claims payment accuracy
Record, track, and monitor provider contract deliverables
Maintain the Provider Manual and update orientation materials as assigned.
Conduct new provider orientation and train providers on the Provider Manual updates and State policy updates
Create and process Vendor Agreements and Single Case agreements as assigned
Lead department process improvement efforts and initiatives
Monitor financial performance of contracts.
Serves as lead on projects as requested by department manager.
Ability to travel
Education/Experience: Bachelor's Degree in healthcare administration, business administration or equivalent experience. 4 years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid services environment.
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.