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.
***NOTE: We are seeking candidates who live near Kansas City, KS for this role***
Position Purpose: 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.
Education/Experience: 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.
For Sunflower Health Plan: Must have prior customer service experience and insurance Claim experience with training in billing. Pay Range: $67,400.00 - $121,300.00 per yearCentene 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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
...At KPMG, you can become an integral part of a dynamic team at one of the world's top tax firms. Enjoy a collaborative, future-forward culture that empowers your success. Work with KPMG's extensive network of specialists & enjoy access to our Ignition Centers, where deep...
...Writer (Remote) We wanted a PBM that worked better so we created one. Liviniti ,... ...Writer . This is a fully remote/work from home position. Role and Responsibilities... ...Retirement Plan with company match immediately 100% vested Required Skills and Competencies...
...Job Description Job Description Position: Certified Surgical Technician (CST)/ (OR) Position Information: working in the OR, assisting surgeons by preparing the surgical field, passing instruments and supplies during surgery, maintaining a sterile environment...
...unforgettable experiences at the confluence of nature, culture, and recreation. Aspen Skiing Company also owns and operates the award-... ...position may cover work areas such as base area, on-mountain, parking lots, bus depots and Lost Forest activities such as the...
...What began as an idea between two brothers to open a Mexican restaurant has since grown into one of the largest, privately held Taco Bell franchisees in America. At Border Foods, we work with a people-first mantra. From cooks to cashiers to restaurant managers and beyond...