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1 Provider Network Specialist I Job in Georgia, GA

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Peach State Health Plan
Georgia, GA | Full Time
$63k-89k (estimate)
2 Months Ago
Provider Network Specialist I
$63k-89k (estimate)
Full Time | Insurance 2 Months Ago
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Peach State Health Plan is Hiring a Provider Network Specialist I Near Georgia, GA

You could be the one who changes everything for our 28 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

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. Bachelor’s degree in healthcare or a related field preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license.Pay Range: $46,500.00 - $79,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

Job Summary

JOB TYPE

Full Time

INDUSTRY

Insurance

SALARY

$63k-89k (estimate)

POST DATE

07/30/2024

EXPIRATION DATE

09/29/2024

WEBSITE

pshpgeorgia.com

HEADQUARTERS

ATLANTA, GA

SIZE

500 - 1,000

FOUNDED

2005

CEO

PATRICK HEALY

REVENUE

$10M - $50M

INDUSTRY

Insurance

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About Peach State Health Plan

Ambetter from Peach State Health Plan offers coverage in the Health Insurance Marketplace. Find the right plan and take control of your health.

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The following is the career advancement route for Provider Network Specialist I positions, which can be used as a reference in future career path planning. As a Provider Network Specialist I, it can be promoted into senior positions as a Provider Programs Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Provider Network Specialist I. You can explore the career advancement for a Provider Network Specialist I below and select your interested title to get hiring information.