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Provider Engagement Administrator I

Company: Centene Medicare
Location: Fall River
Posted on: November 18, 2023

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.


Position Purpose: Acts as a liaison between Tier III and Tier IV providers (small to medium PCP groups not on risk contracts and providers with upside only incentives) and the health plan. Manages Network performance for assigned territory through a consultative/account management approach. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Evaluates provider performance and develops strategic plan to improve performance. Performs detailed HBR analysis. Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.
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

Education/Experience: Bachelor's degree in related field or equivalent experience. 0-2 years of provider relations, provider claims/reimbursement, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor's degree in healthcare or a related field preferred. Claims billing/coding knowledge preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.


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.

Keywords: Centene Medicare, Fall River , Provider Engagement Administrator I, Other , Fall River, Massachusetts

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