Missouri Licensed Provider Engagement Specialist

Job Summary

Acting as a key liaison for provider networking, the full-time Senior Provider Engagement Network Specialist will manage provider setup accuracy, oversee network reporting, and resolve claims payment issues while working remotely from Missouri.

Key responsibilities

• Maintain positive relationships with participating providers and groups, serving as the primary point of contact
• Oversee the administration of contractual provider relationships, ensuring accurate provider databases and providing necessary training
• Research and resolve complex provider-related issues, including contract interpretation and claims data discrepancies

Required qualifications

• Bachelor's degree in a healthcare-related field or equivalent experience
• 5+ years of provider services experience in a managed healthcare environment
• Experience with provider contracting and servicing benefits interpretation
• Strong understanding of internal operations related to provider relations
• Ability to act as a subject matter expert in provider engagement matters