Field Provider Relations & Performance Manager

Centene Corporation; Atlanta (GA); On-site; USD 56,000 - 101,000; Full time

Job summary

Centene Corporation seeks a field-based Provider Relations professional to maintain partnerships between the health plan and provider networks across 30 counties in North Georgia. This role requires residency in one of the listed GA counties and regular travel throughout the territory.

You will serve as the primary contact for providers, triage issues, educate on policies, and manage network performance through consultative/account management.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures; knowledge of Risk Adjustment and VBC preferred.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues for resolution to internal partners.
• Receive and effectively respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Initiate data entry of provider-related demographic information 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.
• Completes special projects as assigned.
• Ability to travel locally 4 days a week.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Provider relations

Account management

HEDIS/Quality measures

Education

Bachelor’s degree or equivalent experience

Job description

Centene Corporation seeks a field-based Provider Relations professional to maintain partnerships between the health plan and provider networks across 30 counties in North Georgia. This role requires residency in one of the listed GA counties and regular travel throughout the territory.

You will serve as the primary contact for providers, triage issues, educate on policies, and manage network performance through consultative/account management.