What are the responsibilities and job description for the Provider Network Support Specialist III position at Sunflower Health Plan?
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 : Ensure Tier I providers (large hospital systems, large health systems, large multi-specialty groups and PCP groups) with downside risk are set up accurately in the provider information systems, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories and claims payment resolution related to provider set up. Provide support to external provider representatives to resolve provider data issues. Research and effectively respond to provider related issues.
- Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG’s), multi-specialty groups, and / or ancillary providers within assigned area.
- Act as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.
- Responsible for daily administration and operation of the contractual provider relationships, including overseeing accurate and current provider databases, providing training, education and information to providers.
- Research, analyze and resolve complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
- Serve as primary point of contact and liaison between assigned providers and the health plan.
- Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues.
- Act as department subject matter expert.
- Participate in special projects.
- Performs other duties as assigned
- Complies with all policies and standards
- 90% Remote and 10% Travel for in office meetings / trainings.
Highly Preferred - Candidates residing in Central Time Zone
Education / Experience : Bachelor’s degree in healthcare related field or equivalent experience required. 5 years of provider services experience required, including experience in a managed health care environment with exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations.
For Sunflower Health Plan : Must have prior customer service experience and insurance Claim experience with training in billing.Pay Range : $55,100.00 - $99,000.00 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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Salary : $55,100 - $99,000
