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
...ERP Software Sales: Looking for a new challenge? Join MetaOption, a Microsoft BC/LS Solution Partner ! Microsoft Dynamics 365 Business Central is growing, and were growing with it. Were looking for commission-basedSales Professional who are eager to take...
...Description Job Summary Arranges accommodations and other travel services for clients, including planning itineraries. General... ...of interest, restaurants and special events. Communicates international travel procedures such as passport, visa, and inoculation...
...Dedicated CDL-A Driver - Kroger - Denver, CO Job Overview: We're seeking CDL-A drivers for a dedicated fleet offering... ...primarily cover Colorado, Southern Wyoming, and Eastern Utah. Distribution centers are located in Aurora, Denver, and Fountain, CO. Schedule...
...you more specific details for this role. Job Description: Additional Job Description 2026 Summer Analyst Program - Corporate Banking (New York) TD Securities is a market leader in Corporate Banking, providing a comprehensive range of financial services and...
...Southern Hens Job Opportunity Incorporated in 1992, Southern Hens is a fully integrated poultry processing company engaged in the processing and distribution of fresh, frozen and canned RTE poultry products. Southern Hens operates three plants at its headquarters in...