Healthcare Network Specialist

3 weeks ago


Omaha, Nebraska, United States Nebraska Total Care Full time
Job Summary

We are seeking a skilled Healthcare Network Specialist to join our team at Nebraska Total Care. As a key member of our organization, you will play a vital role in improving the quality and financial outcomes of our provider network.

Key Responsibilities
  • Conduct comprehensive provider orientations and ongoing educational outreach to enhance the business relationship between providers and the health plan.
  • Educate providers on policies and procedures related to referrals, claims submission, credentialing documentation, and electronic data exchange.
  • Investigate and resolve provider matters, ensuring timely and effective communication with account representatives.
  • Engage providers in Patient-Centered Medical Home initiatives and promote quality improvement strategies.
  • Analyze and report on Health Benefits Ratio (HBR) and Health Information Data Set (HEDIS) metrics to inform provider performance and improvement initiatives.
  • Develop and communicate milestone documents, dashboards, and success metrics to stakeholders.
  • Act as a liaison between providers and the health plan, fostering a collaborative environment to drive financial and quality performance.
  • Provide information and status updates to providers regarding incentive agreements and performance metrics.
  • Conduct site visits as needed to ensure compliance with policies and procedures.
  • Perform other contracting duties as assigned, including recommending changes to pricing subsystems and submitting updates to provider-related database information.
Requirements

To be successful in this role, you will need a Bachelor's degree in a related field or equivalent experience. A minimum of 2 years of combined managed healthcare and provider reimbursement experience is required, with claims processing and/or managed care experience being a plus. A current state driver's license is also necessary.

Candidates must reside in the state of Nebraska and be able to travel locally a minimum of 5 times per month.

Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and a flexible approach to work with remote, hybrid, field, or office work schedules.



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