Healthcare Provider Network Specialist

6 days ago


MagstattleBas, Grand Est, United States Nebraska Total Care Full time
Job Summary

We are seeking a skilled Healthcare Provider Network Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a critical role in improving the quality and financial outcomes of our provider network.

Key Responsibilities
  • Conduct comprehensive provider orientations and ongoing educational outreach to enhance the business relationship between providers and our health plan.
  • Educate providers on policies and procedures related to referrals, claims submission, credentialing documentation, and other key areas.
  • Investigate and resolve provider matters, effectively handling and responding to account changes and correspondence.
  • Engage providers in Patient Centered Medical Home initiatives and provide information on incentive agreements.
  • Perform detailed analyses of HBR and HEDIS metrics, creating reports and dashboards to track provider performance.
  • Act as a liaison between providers and our health plan, ensuring a coordinated effort to improve financial and quality performance.
  • Travel locally 5 times a month minimum to conduct site visits and perform other contracting duties as requested.
Requirements
  • Bachelor's degree in a related field or equivalent experience.
  • 2+ years of combined managed healthcare and provider reimbursement experience, with claims processing and/or managed care experience preferred.
  • Current state driver's license and ability to travel locally.
What We Offer

We offer a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and a flexible approach to work with remote, hybrid, field, or office work schedules.

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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