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Provider Network Support Specialist II

Company: Oklahoma Complete Health
Location: Shawnee
Posted on: November 19, 2023

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 assigned

Education/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, Midwest City , Provider Network Support Specialist II, Other , Shawnee, Oklahoma

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