Centene Corporation Provider Network Specialist II in Independence, Missouri
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 outreach
Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
Enhance 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 initiatives
Perform 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 factors
Create and communicate milestone documents, dashboards and success or improvement metrics
Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
Provide information and status updates for providers regarding incentive agreements
Conduct site visits when required
Perform 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 projects
Ability to travel
Bachelor’s degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Advanced knowledge of Microsoft Excel. Clinical or health information management (HIM) experience preferred. Claims processing and/or managed care experience preferred.Licenses/Certifications: Current state driver’s license. 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. TITLE: Provider Network Specialist II LOCATION: Independence, Missouri REQNUMBER: REA1221309 COMPANY: Business Dev & Sales POSITION TYPE: Both