Provider Performance Specialist II

Centene Corp.; New York (NY); Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. is seeking a Provider Performance Specialist II to remotely support the New York area. You will analyze performance data, discuss results with providers, and collaborate with quality teams to drive better member outcomes.

The role emphasizes proficiency with VBP tools, presenting HBR analyses, and preparing executive reports. Ideal candidates hold a bachelor’s degree or equivalent experience and have 2+ years in managed care or provider reimbursement, with a preference for claims

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of combined managed healthcare and provider reimbursement experience.
• Claims processing and/or managed care experience preferred.

Responsibilities

• Interpret performance data, prioritizing insights and developing discussion and presentation documents.
• Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities.
• Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions.
• Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data.
• Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
• Performs other duties as assigned and complies with all policies and standards.

Skills

Provider analytics

Presentation to stakeholders

Data interpretation

Education

Bachelor’s degree in related field or equivalent experience

Job description

## Provider Performance Specialist IIApply: Remote-NY: Full time: Posted Today: 1661509**Position Purpose:** Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes. **Key Details:** This is a field based position in the New York City area. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT. * Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results. * Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting. * Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions. * Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data. * Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings. * Performs other duties as assigned. * Complies with all policies and standards.**Education/Experience:** Bachelor’s degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Claims processing and/or managed care experience preferred. **For Fidelis Care NY Only:** Valid state clinical license preferred (i.e.- LPN, RN, etc.).Pay Range: $56,200.00 - $101,000.00 per year