Provider Data Management Specialist II

at  Envolve

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. Review and audit provider set ups within business systems to ensure compliance.

• Maintain and update provider data applications and coordinate the data verification process for providers enrolled in networks.
• Oversee and coordinate operational and administrative activities associated with provider relations, including provider education and liaison responsibilities, marketing and promotion, and facilitation of credentialing and certification.
• Manage and resolve complex provider data issues, such as mass change updates, limited reconciliations and direct submissions of urgent requests.
• Coordinate provider data between the health plan database and various external vendors and internal business systems.
• Participate in the reconciliation and provider data projects.
• Oversee the provider termination process including adding and changing new or existing provider records in the medical information system.
• Design and generate reports to monitor department activity, current panel providers and State compliance.

Education/Experience: High school diploma or equivalent. 3+ years of provider data or network administration experience, preferably in managed care. Proficient in Microsoft Office applications, preferably Access and Excel. Database management, reporting, auditing and analysis preferred. Associate’s degree in healthcare or a related field preferred.Pay Range: $22.36 - $38.07 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

• Maintain and update provider data applications and coordinate the data verification process for providers enrolled in networks.
• Oversee and coordinate operational and administrative activities associated with provider relations, including provider education and liaison responsibilities, marketing and promotion, and facilitation of credentialing and certification.
• Manage and resolve complex provider data issues, such as mass change updates, limited reconciliations and direct submissions of urgent requests.
• Coordinate provider data between the health plan database and various external vendors and internal business systems.
• Participate in the reconciliation and provider data projects.
• Oversee the provider termination process including adding and changing new or existing provider records in the medical information system.
• Design and generate reports to monitor department activity, current panel providers and State compliance