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
...SaaS Digital Marketing Executive Full time Da Nang Are you up to become SaaS Digital Marketing Executive at TechSoft? We have recently... ..., and digital campaign execution. ~ Basic knowledge of SEO, online advertising, and marketing analytics is a plus. ~ Proficiency...
...Nutrition Support (Parenteral/Enteral Nutrition), Nutrition Education, Food Service Management, Ability to chart in electronic medical... ..., DE is a one stop solution that offers access to an inclusive network of excellent healthcare professionals through its state-of-the-...
...during or after the project.The main job is to work with the editorial team and other ICIemployees to A) Find, organize, and purge the... ...origin, gender, age, marital status,disability, public assistance status, veteran status, sexual orientation, gender identity, or...
Join to apply for the Criminal Investigator role at Arapahoe County2 days ago Be among the first 25 applicantsJoin to apply for the Criminal Investigator role at Arapahoe County**"Arapahoe County Child and Adult Protection Services positions are hybrid and require 3...
...Overview Cooperidge Consulting Firm is seeking an HVAC Installer/Service Technician. This is a hands-on opportunity to install and service residential and light commercial HVAC systems while working directly with homeowners and businesses. The role is ideal for skilled...