Hybrid Provider Relations & Performance Manager

Superior HealthPlan; Corpus Christi (TX); On-site; USD 56,000 - 101,000; Full time

Job summary

Centene seeks a Provider Relations Specialist to maintain partnerships with contracted provider networks across South Texas. You will build client relations, triage issues, and drive performance in incentive, quality, and cost utilization while traveling across Webb, Nueces, Cameron counties and beyond.

Responsibilities include educating providers on referrals, claims submissions, and policies; investigating and resolving provider claim issues; and developing strategic plans to improve network

Qualifications

• Bachelor’s degree or equivalent experience.
• 2+ years in managed care, provider relations, or related fields.
• Project management experience in medical group/health plan settings.
• Proficient in HEDIS/Quality measures, cost and utilization.

Responsibilities

• Serve as primary contact for providers and act as a liaison between providers and the health plan.
• Triages provider issues as needed for resolution to internal partners.
• Receive and 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 updating orientation materials.
• Manage network performance for the assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in risk, HEDIS/quality, cost and utilization.
• Travel locally 4 days a week and complete special projects as assigned.
• Complies with all policies and standards.

Skills

Provider relations

Quality improvement

HEDIS/Quality measures

Cost utilization

Project management

Utilization management

Claims management

Education

Bachelor's degree or equivalent experience

Job description

Centene seeks a Provider Relations Specialist to maintain partnerships with contracted provider networks across South Texas. You will build client relations, triage issues, and drive performance in incentive, quality, and cost utilization while traveling across Webb, Nueces, Cameron counties and beyond.

Responsibilities include educating providers on referrals, claims submissions, and policies; investigating and resolving provider claim issues; and developing strategic plans to improve network