Full-Time

Provider Engagement Administrator III

Posted on 1/11/2025

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$67.4k - $121.3kAnnually

Senior

Remote in USA

Candidates must live in Oklahoma.

Category
Customer Success Management
Sales & Account Management
Required Skills
Data Analysis
Requirements
  • Bachelor’s degree in related field or equivalent experience.
  • Five + years of combined 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.
Responsibilities
  • Acts as a liaison between Tier I providers (hospital systems, large multi-specialty groups, providers on value-based contracts and/or those with complex contracts) 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 a strategic partner/primary contact for Tier 1 hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components.
  • Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
  • Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level.
  • Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance.
  • Triages provider issues as needed for resolution to internal partners.
  • Receive and effectively respond to external provider related issues.
  • Investigate, resolve and communicate provider high dollar and high volume 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.
  • Evaluates provider performance and develops strategic plan to improve performance.
  • Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC).
  • Acts as a lead for the external representatives.
  • Coaches and trains external representatives.
  • Leads special projects as assigned.
  • Ability to travel locally 4 days a week.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Centene Corporation operates in the healthcare industry, focusing on providing health insurance and services primarily to underinsured and uninsured individuals. The company offers a variety of health insurance products, including medical, dental, vision, and behavioral health services, as well as pharmacy benefits. Centene's business model emphasizes a localized approach, allowing it to tailor its services to meet the specific needs of different communities across the United States. This strategy sets Centene apart from competitors by ensuring that care is relevant and accessible to its members. The company generates revenue through premiums collected from its 27.5 million members, aiming to deliver high-quality and cost-effective healthcare solutions. Centene's goal is to improve health outcomes while managing costs, and it is also committed to corporate sustainability and employee well-being.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • ICHRA growth offers Centene a chance to capture a customizable insurance market.
  • Telehealth expansion, like Blueberry Pediatrics, improves access for underserved populations.
  • Special assistance during emergencies boosts Centene's community support and brand loyalty.

What critics are saying

  • ICHRA market competition may impact Centene's market share.
  • State emergencies could strain Centene's resources, affecting service delivery.
  • Leadership changes, like Ken Fasola's retirement, may cause strategic realignment challenges.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company leads in the Health Insurance Marketplace, serving 27.5 million members.
  • Centene integrates personalized nutrition into healthcare plans, enhancing patient outcomes.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours