Jobs in America

Provider Engagement Administrator II

FULL TIMEUSD 71,000 - 92,000 / year
Bachelor Degree

Thanks to this being a remote job, you can work from any location that allows you to work on projects that are innovative and cutting-edge. If you are offered this job, your salary will be USD 71,000 - 92,000 / year. This job opening demands that you have a minimum qualification of Bachelor Degree to apply for the position. Does full time work align with your career goals? December 22, 2023 marked the start of the job opportunity for the Provider Engagement Administrator II position, which will come to an end on March 21, 2024.

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 aconsultative/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
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.

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.

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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.

If you have read through this job posting carefully, now is the time to decide whether to apply. We encourage you to carefully review the job posting and requirements before submitting an application. If you are confident that you can meet the expectations of this job, we encourage you to apply. In the end, the quality of your job application will be a reflection of your professionalism and attention to detail. Conversely, if you're looking for a job that requires more travel, there are other job vacancies on that might be a better fit.