Provider Engagement Specialist

3 weeks ago


Baton Rouge, Louisiana, United States Centene Corporation Full time
Job Title: Provider Engagement Administrator II

Join Centene Corporation, a leading healthcare company, as a Provider Engagement Administrator II. In this role, you will serve as a liaison between Tier II providers and the health plan, managing network performance for assigned territories through a consultative/account management approach.

Key Responsibilities:
  • Drive provider performance improvement in areas such as risk/P4Q, health benefit ratio (HBR), HEDIS/quality, cost, and utilization.
  • Evaluate provider performance and develop strategic plans to improve performance.
  • Facilitate provider trainings, orientations, and coaching for performance improvement within the network.
  • Triage provider issues for resolution to internal partners.
  • Investigate, resolve, and communicate provider claim issues and changes.
  • Educate providers on 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 territories through a consultative/account management approach.
  • Evaluate provider performance and develop strategic plans to improve performance.
  • Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC).
  • Develop proficiency in tools and value-based performance (VBP) and educate providers on use of tools and interpretation of data.
  • Coach new and less experienced External Reps.
  • Complete special projects as assigned.
Requirements:
  • Bachelor's degree in a related field or equivalent experience.
  • Three years of provider relations, provider claims/reimbursement, or contracting experience.
  • Knowledge of healthcare, managed care, Medicare, or Medicaid.
  • Claims billing/coding knowledge preferred.
What We Offer:

Centene Corporation 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.

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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