Centene Corporation
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Contracting • Network Development • Managed Care
Provider Engagement Administrator - II
April 16
Centene Corporation
Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.
Contracting • Network Development • Managed Care
📋 Description
• 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
🎯 Requirements
• 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 • Claims billing/coding knowledge preferred
🏖️ Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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