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
...on Megaplex, Salt Lake Bees, Real Salt Lake, and Utah Royals Football Club experiences. What Youll Be Doing: As an Assistant Manager, youll be at the heart of it all, ensuring our guests and team have a larger-than-life experience. Youll oversee operations, make...
Overview This role will play a key role in establishing and developing a comprehensive risk management program in line with regulatory requirements for a US investment bank. This role requires someone with hands on experience implementing risk frameworks, policies, procedures...
...Description Introduction Are you seeking PRN career opportunities as an Ambulatory Care Registered Nurse? Join our exceptional team at St. David's North Austin Medical Center, a leading provider of healthcare services within HCA Healthcare. We are excited to...
...and other Government contractors with a team of Engineers and Analysts.You will be supporting one of our Government'score missions... ...will I be doing? Using your subject matter expertise in all-source intelligence analysis instruction, you will: Instruct, develop, and...
...About the job Remote Vacation Planner The world is filled with breathtaking destinations waiting to be explored, and we're here to make those journeys extraordinary. We're seeking passionate, self-motivated individuals to join our team as Remote Resort and Cruise...