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Provider Engagement Administrator II

Company: Delaware First Health
Location: Newark
Posted on: November 20, 2022

Job Description:

You could be the one who changes everything for our 26 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: The Provider Engagement Administrator II is the internal and external liaison for the Provider Network Management Department who maintains positive working relationships with participating physicians, participating physician groups (PPG's), multi-specialty groups, and ancillary providers within an assigned area. Responsible for daily administration and operation of the contractual provider relationships including overseeing accurate and current provider databases, providing training, education and information to providers, coordinating regulatory filings and rollouts, and researching, analyzing and resolving complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility. Act as the internal and external liaison for the Provider Network Department who maintains positive working relationships with participating physicians, participating physician groups (PPG's), multi-specialty groups, and/or ancillary providers within an assigned area. Acts as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.
Responsible for daily administration and operation of the contractual provider relationships including overseeing accurate and current provider databases, providing training, education and information to providers
Researching, analyzing and resolving complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
Participates in special projects
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: Master's degree in healthcare related field preferred. Three or more years of progressive provider services experience. Experience in a managed health care environment with exposure to provider contracting, servicing benefits interpretation, and internal operations of provider relations function required. Intermediate demonstrated analytical skills; Intermediate demonstrated problem solving skills; Intermediate to advanced Microsoft Excel.

License/Certification: Driver's license required. 60-80% local travel, with rare need for overnight travel.

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: Delaware First Health, Newark , Provider Engagement Administrator II, Other , Newark, Delaware

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