Provider Network Support Specialist I

Company: Sunshine State Health Plan
Location: Miami
Posted on: September 24, 2024

Job Description:

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.

* Qualified candidates must reside in Florida ---* Position Purpose: Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up.

• Provide support to the external provider representative to resolve provider data issues
• Research and effectively respond to provider related issues
• Submit provider data entries to resolve provider-related demographic information changes
• Initiate and process provider add, change and termination forms
• Create and maintain spreadsheets used to produce provider directories for multiple products.
• Track, update and audit provider data
• Identify adds, deletes and updates to key provider groups and model contracts
• Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
• Provide assistance to providers with website registration
• Facilitate provider education via webinar
• Work with other departments on cross functional tasks and projects
• Facilitate new provider orientations
• Facilitate provider trainings
• Completes special projects as assigned Education/Experience: Associates degree and claims processing, billing and/or coding experience preferred. Three years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims. Knowledge of health care, managed care, Medicare or Medicaid. Intermediate Demonstrated interpersonal/verbal communication skills, Intermediate Demonstrated written communication skills, Intermediate Demonstrated organizational skills, Intermediate Demonstrated time management and priority setting skills, Intermediate Demonstrated customer service skills, Intermediate Ability to represent the company with internal constituents, Intermediate Ability to work independently, Intermediate Ability to multi-task, Intermediate Demonstrated problem solving skills, Intermediate Demonstrated analytical skills. Required, Intermediate Microsoft Excel, Intermediate Microsoft Outlook and Intermediate Microsoft Word.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.
  Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Keywords: Sunshine State Health Plan, Miami , Provider Network Support Specialist I, Other , Miami, Florida