Provider Data Management Specialist I

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: Maintain accurate databases and reports to monitor network compliance with State requirements

• Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections
• Oversee the provider termination process including adding and changing new or existing provider records in the medical information system
• Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes
• Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance
• Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
• Perform general administrative tasks in support of assigned department

HIGHTLY PREFERRED

• Claims experience

• Credentialing experience

• Provider Data Management experience

• Provider Network Operations experience

• Residence of Kansas or the Kansas City, Missouri Metropolitan area

Education/Experience: High school diploma or equivalent. 2+ years of provider data or network administration experience, preferably in a managed care setting. Proficient in Microsoft Office applications, preferably Access and Excel. Previous experience with database management, reporting and analysis preferred. Associate’s degree in health care or a related field preferred.
For Sunflower plan only: 2+ years of experience, preferably in a managed care setting.

Pay Range: $18.66 - $31.73 per hour

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