Provider Engagement Administrator III Job at Sunflower Health Plan, Topeka, KS

VHM1Tmg0N05zY0hoNXUyVzdrMFpvR2hXZkE9PQ==
  • Sunflower Health Plan
  • Topeka, KS

Job Description

Job Description

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.

  • 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

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 year

Centene 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

Job Tags

Holiday work, Remote job, Flexible hours,

Similar Jobs

EVONA

BD Associate Job at EVONA

With access to new frontiers becoming more affordable, the potential for exploration and innovation is growing exponentially. This company is at the forefront, delivering advanced technologies that enable safe, cost-effective solutions for operations in challenging environments...

Community College of Allegheny County

Studio Art Model Temporary Pool Job at Community College of Allegheny County

 ...Studio Art Model Temporary Pool Position Title: Studio Art Model Temporary Pool Department: Academics Campus: College Wide Additional Information: Please note: If you are a PSERS retiree, per PSERS guidelines, employment by the College as an adjunct faculty... 

ACIES TRANSPORT

Owner Operator - Sprinter/Cargo Van/Conestoga/Box Truck Job at ACIES TRANSPORT

 ...ACIES TRANSPORT is a dispatch company looking for Sprinter/Cargo Vans, Box Trucks, and Conestoga/Curtain side Owner-Operators to cooperate with (Independent Contractor Agreement) Requirements: Own a Cargo van / Sprinter van, Box Truck, or Conestoga (2011 and newer,... 

BJC HealthCare

ICU Clinical Nurse - Nights Job at BJC HealthCare

 ...differentiates BJC as the place for nurses to work in the greater St. Louis area. This is a tool to empower nurses to work at the...  ...Missouri Baptist Medical Center , an acute care hospital in St. Louis County, offers a full continuum of medical and surgical... 

AdventHealth Primary Health Division

Internal Medicine Physician Job at AdventHealth Primary Health Division

 ...AdventHealth Primary Care Network is seeking a board certified, experienced Internal Medicine physician for an outpatient primary care practice. Located in the highly sought...  ...as a destination city for youth sports, Orlando s youth have incredible opportunities...