Provider Network Specialist II - Tempe, United States - Oklahoma Complete Health

Oklahoma Complete Health Tempe, United States

3 days ago

Description

Provider Network Specialist II page is loaded Provider Network Specialist II Apply locations Tempe W. Rio Salado Pkwy (Corp Remote-AZ time type Full time posted on Posted 2 Days Ago job requisition id You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network.

Act as liaison between providers and the health plan to enhance the business relationship.

Conduct initial provider orientations as well as ongoing educational outreachEducate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data InterfaceEnhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence.

Engage providers and educate them on Patient Centered Medical Home initiativesPerform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factorsCreate and communicate milestone documents, dashboards and success or improvement metricsAct as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performanceProvide information and status updates for providers regarding incentive agreementsConduct site visits when requiredPerform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special projectsAbility to travelPerforms other duties as assignedComplies with all policies and standardsCandidate must reside in the state of ArizonaEducation/Experience:
Bachelors degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Claims processing and/or managed care experience preferred.

Licenses/Certifications:
Current state drivers license

Pay Range:
$54, $97,100.00 per year 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.

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.

Welcome Thanks for your interest in Centene and its subsidiary companies.

Were so glad that youve decided to fill out an application and take the next step to find your purpose.

Also, were here to help support you on your candidate journey. Should you need an accommodation, please email .About Us Centene is committed to helping people live healthier lives.

We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

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