Provider Engagement Administrator I

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 III and 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 planTriages provider issues as needed for resolution to internal partnersReceive and effectively respond to external provider related issuesInvestigate, resolve and communicate provider claim issues and changesInitiate data entry of provider-related demographic information changesEducate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topicsPerform provider orientations and ongoing provider education, including writing and updating orientation materialsManages Network performance for assigned territory through a consultative/account management approachEvaluates provider performance and develops strategic plan to improve performanceDrives provider performance improvement in the following areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.Completes special projects as assignedAbility to travel locally 4 days a weekPerforms other duties as assignedComplies with all policies and standards

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.

Candidates must reside in the state of Georgia in one of the following counties to be considered for this position Ben Hill, Cook, Coffee, Lowndes, Irwin, Clinch, Tift, Turner Counties.

This role requires 3-4 days/week of local travel/field work, but allows remote work from home when not in the field.

Pay Range $46,500.00 - $79,200.00 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.