Provider Relations Specialist II (MLTC)

Company: Fidelis Care
Location: Flushing
Posted on: May 28, 2023

Job Description:

You could be the one who changes everything for our 26 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.

$3k Sign on Bonus

Position Purpose: The MLTC (Managed Long-term Care) Provider Relations Specialist will work with MLTC providers such as Skilled Nursing Facilities (SNFs), Home Care, SADCs, CDPAS and PCAs. The MLTC specialist will be required to engage with providers on a 1 to 1 basis to meet provider engagement requirements and to educate on policies procedures, conduct site visits as needed and work to resolve claims issues.

--- Conduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website
--- Monitor financial performance of contracts
--- Investigate and document provider changes and correspondence
--- Coordinate with credentialing to ensure all appropriate documentation is received
--- Serve as a lead for key special projects
--- Recommend changes in pricing subsystems
--- Coordinate printing of provider directories with corporate and plan level entities
--- Investigate and respond to complex provider related issues and initiate change of provider related database information
--- Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff
--- Ability to travel

Education/Experience: High school diploma or equivalent. Bachelor's degree in healthcare related field preferred. 5+ years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans.

License/Certification: Valid driver's license.

For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.
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.

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Pay Range: $52,900.00 - $95,200.00 per year

Keywords: Fidelis Care, New York , Provider Relations Specialist II (MLTC), Other , Flushing, New York