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Provider Engagement Specialist

2 months ago

Miami, Florida, United States Centene Corporation Full time

Job Summary:

We are seeking a highly skilled Provider Engagement Specialist to join our team at Centene Corporation. As a key member of our organization, you will serve as the primary contact for providers and act as a liaison between the providers and our health plan.

Key Responsibilities:

  • Serve as primary contact for providers and act as a liaison between the providers and the health plan
  • Triage provider issues as needed for resolution to internal partners
  • Receive and effectively respond to external provider-related issues
  • Investigate, resolve, and communicate provider claim issues and changes
  • Initiate data entry of provider-related demographic information changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics
  • Perform provider orientations and ongoing provider education, including writing and updating orientation materials
  • Manage network performance for assigned territory through a consultative/account management approach
  • Evaluate provider performance and develop strategic plans to improve performance
  • Drive provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization, etc.
  • Complete special projects as assigned
  • Ability to travel locally 4 days a week
  • Perform other duties as assigned
  • Comply with all policies and standards

Acts as a liaison between Tier III and Tier IV providers (small to medium PCP groups not on risk contracts and providers with upside-only incentives) and the health plan. Manages network performance for assigned territory through a consultative/account management approach. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization, etc. Evaluates provider performance and develops strategic plans to improve performance. Performs detailed HBR analysis. Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.

Requirements:

  • Bachelor's degree in a related field or equivalent experience
  • 0-2 years of provider relations, provider claims/reimbursement, or contracting experience
  • Knowledge of healthcare, managed care, Medicare, or Medicaid
  • Bachelor's degree in healthcare or a related field preferred
  • Claims billing/coding knowledge preferred

Compensation:

Pay Range: $46,500.00 - $79,200.00 per year

Centene 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.