Provider Data Management Specialist I

Company: Sunshine State Health Plan
Location: Pompano Beach
Posted on: August 26, 2024

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.
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 departmentEducation/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.
  
  Pay Range: $18.66 - $31.73 per hourCentene 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.

Keywords: Sunshine State Health Plan, Pompano Beach , Provider Data Management Specialist I, Executive , Pompano Beach, Florida