Job Details
**Provider Network Support Specialist I**
Category Business Dev & Sales Location Kapolei, Hawaii, US Full-time Job Id 1290038 Ohana Health Plan JOB DESCRIPTION You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.
**NOTE: This position requires a the candidate to travel up to 50% of the time within Oahu**
******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
**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:******
* 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.
* Additional skills: interpersonal/verbal & written communication skills, organizational skills, time management and priority setting, customer service, ability to work independently and multi-task, problem solving & analytical skills
*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.*
Category Customer Care Location Honolulu, Hawaii, US Category Customer Care Location Orlando, Florida, US Category Clinical & Care Management Location Rancho Cordova, California, US Category Legal & Compliance Location Kapolei, Hawaii, US