Provider Partnership Associate

Fidelis Care - New York; New York (NY); Remote; USD 55,000 - 99,000; Full time

Job summary

An established industry player is seeking a Provider Partnership Associate to enhance the quality and financial outcomes within their provider network. This role involves conducting orientations, educating providers about essential policies, and engaging them in initiatives that prioritize patient-centered care. With a focus on collaboration and improvement, you will analyze performance metrics and serve as a liaison between providers and the health plan. Enjoy the flexibility of a remote position with local travel opportunities, while contributing to the health of communities and making a significant impact on the lives of millions.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 3+ years of managed healthcare and provider reimbursement experience.
• Clinical or health information management experience preferred.

Responsibilities

• Conduct provider orientations and ongoing educational outreach.
• Engage providers on Patient Centered Medical Home initiatives.
• Perform detailed Health Benefits Ratio analysis and create reports.

Skills

Managed Healthcare

Provider Reimbursement

Health Information Management

Data Analysis

Communication Skills

Education

Bachelor’s Degree in a related field

Job description

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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.

Position Purpose

Perform initial health plan orientation and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within provider network.

Responsibilities

1. Conduct initial provider orientations as well as ongoing educational outreach.
2. Educate providers regarding policies and procedures related to referrals, claims submission, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
3. Engage providers on Patient Centered Medical Home initiatives.
4. Perform detailed HBR (Health Benefits Ratio) analysis and create reports for provider review.
5. Review provider performance by both quantitative metrics and qualitative factors.
6. Create and communicate milestone documents, dashboards, and success metrics.
7. Act as a liaison between the provider and the health plan, ensuring a coordinated effort in improving financial and quality performance.
8. Provide status updates for providers regarding incentive agreements.
9. Conduct site visits when required and perform other contracting duties as requested.
10. Ability to travel.
11. Perform other duties as assigned.
12. Comply with all policies and standards.

Education/Experience

Bachelor’s Degree in a related field or equivalent experience. 3+ years of managed healthcare and provider reimbursement experience. Clinical or health information management (HIM) experience preferred. Current state driver’s license.

Additional Requirements for Fidelis Care

Must have a valid driver’s license, personal vehicle, and ability to travel.

This role is remote/field-based, requiring 50% local travel to see providers in person. Candidates must be in the downstate New York/New York City area.

Compensation and Benefits

Pay Range: $55,100.00 - $99,000.00 per year.

Centene offers comprehensive benefits including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work schedules (remote, hybrid, field, or office).

Actual pay will be based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Equal Opportunity Employment

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.