Provider Network Support Specialist II
Company: Oklahoma Complete Health
Location: Oklahoma City
Posted on: September 10, 2023
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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.Oklahoma Complete Health, a Centene
company, is committed to providing quality healthcare solutions to
transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and
change-makers in search of an inclusive culture grounded by our
commitment to work-life balance, competitive compensation, and
continuous career development. Join us and be a part of a
collaborative, growing network of innovative thinkers delivering
solutions at the local level.
***Must Reside in Oklahoma***
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
--- - - Act as liaison for small PCP groups (as designated by
departmental leadership). -
--- - Coaches new hires and less experienced Internal Reps.
--- - - -Completes special projects as
assignedEducation/Experience: Associates degree and claims
processing, billing and/or coding experience preferred. Five +
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.Our Comprehensive
Benefits Package: Flexible work solutions including remote options,
hybrid work schedules and dress flexibility, Competitive pay, Paid
time off including holidays, Health insurance coverage for you and
your dependents, 401(k) and stock purchase plans, Tuition
reimbursement and best-in-class training and development.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.
Keywords: Oklahoma Complete Health, Oklahoma City , Provider Network Support Specialist II, Other , Oklahoma City, Oklahoma
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