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Overview

Provider Network Specialist I Jobs in Fort Lauderdale, FL at Sunshine State Health Plan

Title: Provider Network Specialist I

Company: Sunshine State Health Plan

Location: Fort Lauderdale, FL

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 duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
Receive and effectively respond to external provider related issues
Provide education on health plan’s innovative contracting strategies
Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
Investigate, resolve and communicate provider claim issues and changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
Perform provider orientations and ongoing provider education, including writing and updating orientation materials
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:
Bachelor’s degree in related field or equivalent experience.
0-2 years of provider relations or contracting experience.
Knowledge of health care, managed care, Medicare or Medicaid.
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.

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About Sunshine State Health Plan