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
Job Description Job Description Finance and Insurance (F&I) Manager Automotive This is an incredible opportunity for an experienced professional who is excited by automotive F&I and passionate about customer service. We are currently seeking an F&I manager to ...
...Job Description Job Description Mid-sized architecture firm seeking junior and intermediate architects for hire. Eligible candidates must have between 2-5 years experience within an architectural firm, a strong knowledge of preparing design and construction documents...
...~ Strong proficiency in Python and SQL for data manipulation and analysis ~ Experience with data visualization tools such as Power BI or Tableau ~ Ability to work with large datasets and perform data cleansing and validation ~ Excellent problem-solving skills...
...- $1800 per week Schedule: Home nightly Freight: No touch freight Account Type: Dedicated Account Endorsements: TWIC required What Youll Need: CDL-A license with at least 12 months of solo driving Must pass DOT drug test and physical...
...Cook Portland Sports Complex Cook - Portland Sports Complex Sports Facilities Management, LLC LOCATION: Portland, TX DEPARTMENT: FOOD & BEVERAGE REPORTS TO... ...developing sports, recreation, wellness, and events facilities. We provide a highly collaborative...