Provider Engagement Specialist
4 weeks ago
We are seeking a highly skilled Provider Engagement Administrator to join our team at Centene Corporation. As a key member of our organization, you will play a critical role in driving provider performance improvement and ensuring the success of our healthcare initiatives.
Key Responsibilities:- Act as a liaison between Tier III and Tier IV providers and the health plan, facilitating effective communication and collaboration.
- Manage Network performance for assigned territory through a consultative/account management approach, driving provider performance improvement in key areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
- Evaluate provider performance and develop strategic plans to improve performance, including detailed HBR analysis and provider trainings, orientations, and coaching.
- Serve as primary contact for providers, acting as a liaison between the providers and the health plan, and triaging provider issues as needed for resolution to internal partners.
- Investigate, resolve, and communicate provider claim issues and changes, and 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, and perform provider orientations and ongoing provider education.
- 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.
- Claims billing/coding knowledge preferred.
- Behavioral health experience strongly preferred.
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.
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different.
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