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    provider engagement administrator ii - Baton Rouge, LA, United States - Centene Corporation

    Centene Corporation
    Centene Corporation Baton Rouge, LA, United States

    1 week ago

    Default job background
    Description
    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, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.


    Position Purpose: Acts as a liaison between Tier II providers (large 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.


    • Serve as primary contact for providers and act as a liaison between the providers and the health plan
    • Triages provider issues as needed for resolution to internal partners
    • Receive and effectively respond to external provider related issues
    • Investigate, resolve and communicate provider claim issues and changes
    • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
    • Perform provider orientations and ongoing provider education, including writing and updating orientation materials
    • Manages Network performance for assigned territory through a consultative/account management approach
    • Evaluates provider performance and develops strategic plan to improve performance

    Drives provider performance improvement in the following areas:
    Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.

    Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

    Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data

    Coaches new and less experienced External Reps

    Completes special projects as assigned

    Ability to travel locally 4 days a week

    Performs other duties as assigned

    Complies with all policies and standards


    Education/Experience: Bachelor's degree in related field or equivalent experience. Three 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 in the state of Louisiana will be prioritized for this position.

    Anyone outside of the state will ne required to travel to Louisiana for quarterly meetings and adjust their work schedule to align with folks on Central Time.

    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.

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