Provider Engagement Account Manager

Centene; United States; Remote; USD 55,000 - 99,000; Full time

Job summary

An established industry player is seeking a dedicated professional to enhance provider relations and ensure optimal network performance. In this role, you will serve as the primary contact for providers, resolving issues and improving performance metrics. You will engage with providers to educate them on policies and enhance their understanding of claims submission processes. This position offers a flexible work environment with opportunities for remote, hybrid, or on-site work. Join a company that values diversity and offers competitive benefits, including health insurance and tuition reimbursement, to make a meaningful impact in healthcare.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Bachelor’s degree or equivalent experience in a related field required.
• Two years of managed care or provider relations experience preferred.

Responsibilities

• Serve as primary contact for providers and manage relationships.
• Investigate and resolve provider claim issues and changes.
• Drive provider performance improvement in various metrics.

Skills

Provider Relations

Project Management

Quality Improvement

Claims Management

Utilization Management

Education

Bachelor’s degree in related field

Two years of managed care experience

Tools

HEDIS

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.

* Qualified candidates must reside in Florida

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization.

Key Responsibilities:

• 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
• 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

Education/Experience:

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, cost and utilization.

Pay Range: $55,100.00 - $99,000.00 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