Job description

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Acts as a liaison between Tier III and Tier IV providers (small to medium PCP groups not on risk contracts and providers with upside only incentives) and the health plan. Manages Network performance for assigned territory through a consultative/account management approach. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Evaluates provider performance and develops strategic plan to improve performance. Performs detailed HBR analysis. Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.

Act as the internal and external liaison for the Provider Network Management Department who maintains positive working relationships with participating physicians, participating physician groups (PPG’s), multi-specialty groups, and/or ancillary providers within an assigned area. Acts as account manager for assigned groups acting as gatekeeper for interactions with other internal departments.
Responsible for daily administration and operation of the contractual provider relationships including overseeing accurate and current provider databases, providing training, education and information to providers
Researching, analyzing and resolving complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
Special projects as assigned.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 0-2 years of provider relations, provider claims/reimbursement, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare or a related field preferred. Claims billing/coding knowledge preferred.

Candidates MUST reside in one of the following Kentucky counties to be considered: Logan, Simpson, Allen, Monroe, Cumberland, Clinton, Wayne, McCreary, Pulaski, Russell, Adair, Metcalfe, Barren, Warren, Butler, Edmonson, Hart, Green, Taylor, Casey, Marion, Larue, Hardin, Grayson, Breckinridge, Meade, Bullitt, Nelson, Washington, Spencer, Shelby, Henry, Carroll, Trimble, Oldham, Jefferson.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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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