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: This is a field based position with 75% travel to the following parishes: Assumption, Lafourche, St. Charles, St. Mary, St. James, St. John the Baptist and Terrebonne. We are seeking individuals who reside in these areas

　　Position Purpose: Acts as a liaison between Tier II providers (large PCP groups not on risk contracts and providers with upside only incentives) 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 primary contact for providers and act as a liaison between the providers and the health plan

　　Triages provider issues as needed for resolution to internal partners

　　Receive and effectively respond to external provider related issues

　　Investigate, resolve and communicate 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

　　Perform provider orientations and ongoing provider education, including writing and updating orientation materials

　　Manages Network performance for assigned territory through a consultative/account management approach

　　Evaluates provider performance and develops strategic plan to improve performance

　　Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.

　　Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)

　　Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data

　　Coaches new and less experienced External Reps

　　Completes special projects as assigned

　　Ability to travel locally 4 days a week

　　Education/Experience: Bachelor’s degree in related field or equivalent experience. Three years of 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.Pay Range: $52,900.00 - $95,200.00 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.