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

You match the following Centene's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
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 approach is localized, allowing it to tailor its services to meet the specific needs of different communities across the United States. This strategy sets it apart from competitors by ensuring that care is relevant and accessible to its members. Centene generates revenue through premiums collected from its 27.5 million members, aiming to deliver high-quality and cost-effective healthcare solutions. The company's goal is to improve health outcomes while addressing social barriers to health and promoting sustainability, all while supporting the well-being of its employees.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of telehealth services enhances access for underserved populations.
  • ICHRA introduction attracts customers seeking personalized, flexible insurance options.
  • Essential Plan expansion highlights growth potential in low-cost insurance markets.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may impact Centene's market share.
  • Potential regulatory changes in Medicaid and Medicare could affect revenue streams.
  • Economic downturns may decrease premium collections, impacting financial performance.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

INACTIVE