Healthcare Liaison Specialist

3 weeks ago


Topeka, Kansas, United States Centene Corporation Full time
Job Summary

We are seeking a skilled Healthcare Liaison Specialist to join our team at Centene Corporation. This role will serve as a liaison between Tier I providers and the health plan, managing network performance and driving provider performance improvement.

Key Responsibilities
  • Act as a liaison between Tier I providers and the health plan
  • Manage network performance for assigned territory through a consultative/account management approach
  • Drive provider performance improvement in areas such as risk, health benefit ratio, HEDIS/quality, cost, and utilization
  • Evaluate provider performance and develop strategic plans to improve performance
  • Facilitate provider trainings, orientations, and coaching for performance improvement
  • Serve as a strategic partner/primary contact for Tier 1 hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components
  • Execute provider performance improvement strategies in areas such as risk, health benefit ratio, HEDIS/quality, cost, and utilization
  • Build strong interpersonal relationships with cross-functional teams both externally and internally
  • Expert proficiency in tools and value-based performance (VBP) to educate providers and improve performance
  • Triage provider issues as needed for resolution to internal partners
  • Receive and effectively respond to external provider-related issues
  • Investigate, resolve, and communicate provider high-dollar and high-volume provider claim issues and changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics
  • Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
  • Act as a lead for external representatives
  • Coach and train external representatives
  • Lead special projects as assigned
Requirements
  • Bachelor's degree in a related field or equivalent experience
  • Five+ years of combined 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.

We are an equal opportunity employer 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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