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Provider Engagement Specialist III

2 months ago

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

We are seeking a highly skilled Provider Engagement Specialist III to join our team at Centene Corporation. As a key member of our healthcare team, you will be responsible for building and maintaining strong relationships with our network providers, driving performance improvement, and ensuring seamless operations.

Key Responsibilities
  • Act as a liaison between Tier I providers and the health plan, managing network performance and driving provider performance improvement in key areas such as risk, quality, and utilization.
  • Evaluate provider performance and develop strategic plans to improve performance, including detailed HBR analysis and report creation for Joint Operating Committee meetings.
  • Facilitate provider trainings, orientations, and coaching for performance improvement within the network, and assist with claim resolution.
  • Serve as a strategic partner and 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 key areas, including risk, quality, and utilization.
  • Build strong interpersonal relationships with cross-functional teams both externally and internally, including C-suite level executives.
  • Expert proficiency in tools and value-based performance (VBP) to educate providers and improve performance.
  • Triage provider issues for resolution to internal partners, receive and respond to external provider-related issues, and investigate, resolve, and communicate provider high-dollar and high-volume claim issues.
  • Educate providers on policies and procedures related to referrals and claims submission, website usage, EDI solicitation, and related topics.
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
  • Competitive pay and benefits package, including health insurance, 401K, and stock purchase plans.
  • Tuition reimbursement and paid time off plus holidays.
  • A flexible approach to work with remote, hybrid, field, or office work schedules.