What are the responsibilities and job description for the Provider Engagement Administrator III position at Meridian Illinois?
Position Purpose:
The Provider Engagement Administrator 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), hospitals, complex academic groups, multi-specialty groups, and/or 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 Management Department who maintains positive working relationships with participating physicians, participating physician groups (PPG’s), hospitals, complex academic groups, 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.
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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
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Researching, analyzing and resolving complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
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Coaches/assists Provider Engagement Administrators I and II
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Assists department leadership with coordinating regulatory filings and rollouts and special projects
Education/Experience:
Master’s degree in health care field or MBA preferred. Five 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. Advanced demonstrated analytical skills; Advanced demonstrated problem solving skills; Intermediate to advanced Microsoft Excel.
License/Certification:
Driver’s license required. 40-60% local travel, may require overnight travel.
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.
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