Location: Lawrence, IN
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. 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 Initiate data entry of provider-related demographic information 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.
Completes special projects as assigned Ability to travel locally 4 days a week 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. 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, interaction, interactionual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
For more details: jobs-search. org/tourism_lawrence-c430595/provider-engagement-administrator-i-lawrence_i1967860288
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Administrative/Clerical jobs refer to roles that primarily involve office support tasks such as data entry, phone handling, scheduling, filing, and assisting executives. Those in administrative and clerical positions are the organizational backbone of an office and are responsible for the seamless flow of information. They require strong organizational skills, attention to detail, and the ability to handle multiple tasks simultaneously. These roles often require competency in computer software, customer service, and communication. The work is typically performed in an office environment, providing the foundational support that keeps the daily operations of a business running smoothly.
