Provider Relations Specialist II at Centene Corp in Rego Park, NY
Position Purpose:
Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claimsConduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website Monitor financial performance of contracts Investigate and document provider changes and correspondence Coordinate with credentialing to ensure all appropriate documentation is received Serve as a lead for key special projects Recommend changes in pricing subsystems Coordinate printing of provider directories with corporate and plan level entities Investigate and respond to complex provider related issues and initiate change of provider related database information Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff Ability to travel Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility Competitive pay Paid Time Off including paid holidays Health insurance coverage for you and dependents 401(k) and stock purchase plans Tuition reimbursement and best-in-class training and development Education/
Experience:
High school diploma or equivalent. Bachelor's degree in healthcare related field preferred. 5
years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans. For Fidelis Care only:
Must have valid driver license, personal vehicle and ability to travel.
Salary Range:
$80K -- $100K
Minimum Qualification
Sales, Pharmaceutical/Medical SalesEstimated Salary: $20 to $28 per hour based on qualifications.
Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claimsConduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website Monitor financial performance of contracts Investigate and document provider changes and correspondence Coordinate with credentialing to ensure all appropriate documentation is received Serve as a lead for key special projects Recommend changes in pricing subsystems Coordinate printing of provider directories with corporate and plan level entities Investigate and respond to complex provider related issues and initiate change of provider related database information Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff Ability to travel Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility Competitive pay Paid Time Off including paid holidays Health insurance coverage for you and dependents 401(k) and stock purchase plans Tuition reimbursement and best-in-class training and development Education/
Experience:
High school diploma or equivalent. Bachelor's degree in healthcare related field preferred. 5
years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans. For Fidelis Care only:
Must have valid driver license, personal vehicle and ability to travel.
Salary Range:
$80K -- $100K
Minimum Qualification
Sales, Pharmaceutical/Medical SalesEstimated Salary: $20 to $28 per hour based on qualifications.
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