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in Crowley, LA

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Hours Full-time, Part-time
Location Crowley, Louisiana

About this job

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. ***NOTE: This is a hybrid role (home/field) traveling within the target areas of Houma and Thibodaux, Louisiana. This position travels within the cities listed above, up to three days a week, on average. We are seeking individuals who reside in Houma or Thibodaux or one of the following parishes, Terrebonne, Lafourche, St. Mary, Assumption, St. James, St. John or St. Charles*** Position Purpose: Acts as a liaison between Tier II providers (large 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. 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 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. Create reports for quality-focus meetings and Joint Operating Committee meetings (JOC) Develop proficiency in and educate providers on use of tools and interpretation of data Completes special projects as assigned Ability to travel locally three days a week Education/Experience: Bachelor’s degree in related field or equivalent experience. Three 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. Also open to candidates with provider-side experience. 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.