Provider Engagement Specialist
3 weeks ago
We are seeking a highly skilled Provider Engagement Specialist to join our team at Centene. As a key member of our organization, you will play a critical role in driving provider performance improvement and ensuring the success of our network.
Key Responsibilities- Provider Liaison: Serve as the primary point of contact for providers, acting as a liaison between them and our health plan.
- Network Performance Management: Manage network performance for assigned territories through a consultative/account management approach.
- Performance Improvement: Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
- Strategic Planning: Evaluate provider performance and develop strategic plans to improve performance.
- Training and Education: Facilitate provider trainings, orientations, and coaching for performance improvement within the network.
- Claim Resolution: Assist with claim resolution and investigate, resolve, and communicate provider claim issues and changes.
- Data Entry: Initiate data entry of provider-related demographic information changes.
- Policy and Procedure Education: Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics.
- Education: Bachelor's degree in a related field or equivalent experience.
- Experience: 0-2 years of provider relations, provider claims/reimbursement, or contracting experience.
- Knowledge: Knowledge of healthcare, managed care, Medicare, or Medicaid.
- Competitive Pay: $46, $79,200.00 per year.
- Comprehensive Benefits Package: Health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, and a flexible approach to work.
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. We are a national organization transforming the health of our communities, one person at a time.
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