Centene Corporation Provider Relations & Contracting Specialist I in Pittsburgh, Pennsylvania

ProfessionalPosition Purpose: Serves as a liaison between providers, the health plan and Corporate. Responsible for investigating and resolving provider issues and conducting new provider orientations and educating providers on policies and procedures.

  • 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

  • Audit provider insurance policies to confirm compliance with contract requirements

  • Conduct provider contract compliance administrative audits.

  • Create and process Vendor Agreements and Single Case agreements as assigned.

  • Ability to travel

Education/Experience: Bachelor’s Degree in healthcare administration, business administration or equivalent experience. 2+ years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid service environment.

Licenses/Certifications: Current state driver’s license.

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.

TITLE: Provider Relations & Contracting Specialist I

LOCATION: Pittsburgh, Pennsylvania

REQNUMBER: 1120142

COMPANY: Network Development & Contracting

POSITION TYPE: Professional