Provider Network Contracting Specialist

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 including investigating and resolving provider issues. Perform new provider orientations and educate providers regarding the provider manual, and contract requirements. Serves as a resource for department staff and provides training as need.

• Serve as contact for provider inquires and track inquiries and response times.
• Draft contracts and manage contracting process to verify that contract deadlines are met
• Monitor provider credentialing activities and contact providers for missing or incomplete information
• Maintain and update provider databases to include key provider demographics and specialty provider information
• Conduct administrative audits of provider agencies to evaluate provider contract adherence
• Review, audit and price contract related pends to verify claims payment accuracy
• Record, track, and monitor provider contract deliverables
• Maintain the Provider Manual and update orientation materials as assigned.
• Conduct new provider orientation and train providers on the Provider Manual updates and State policy updates
• Create and process Vendor Agreements and Single Case agreements as assigned
• Lead department process improvement efforts and initiatives
• Monitor financial performance of contracts.
• Serves as lead on projects as requested by department manager.
• Ability to travel
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s Degree in healthcare administration, business administration or equivalent experience. 4+ years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid services environment.
Licenses/Certifications: Current state driver’s license.

This position is remote within the state of California, with onsite meetings required.

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