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Provider Network Specialist II

Company: Centene
Location: Seattle
Posted on: January 15, 2022

Job Description:

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.Coordinated Care -and -Centene Corporation -believe quality healthcare is best delivered locally. Our local approach enables us to provide our members with high-quality and culturally sensitive healthcare services, and our hiring practices reflect the composition of the members and communities we serve.We are looking to hire a -Provider Network Specialist II -in or near Seattle, Tacoma, or Spokane. - You will be the face of our health plan to our providers helping to enhance the business relationship. - -Highly qualified candidates will have proven experience in a provider facing role, data analytic experience, claims experience and solid excel skills. -Top notch written and verbal communication skills are a must.Do you have experience in Provider Relations, Contracting, or Network Administration? If so, we would like to speak to you!Additional duties may be as follows-Conduct initial provider orientations as well as ongoing educational outreachEducate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data InterfaceEnhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence.Engage providers and educate them on Patient Centered Medical Home initiativesPerform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factorsCreate and communicate milestone documents, dashboards and success or improvement metricsAct as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performanceProvide information and status updates for providers regarding incentive agreementsConduct site visits when requiredPerform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special projectsOur Comprehensive Benefits Package:Flexible work solutions including remote options, hybrid work schedules and dress flexibilityCompetitive payPaid Time Off including paid holidaysHealth insurance coverage for you and dependents401(k) and stock purchase plansTuition reimbursement and best-in-class training and developmentKey Words: -Billing, Claims Liaison, Provider Relations, Provider Network, Provider Liaison, Network Coordinator, Network Representative, STARS, Provider Groups, Reimbursement, Analyst, Provider Education, Educate, Healthcare, Engagement, Manager, Claims, Managed Care, MCO, Healthcare, Health, LTAC, Physician Group, JOC, CMS 1500, AHCCCS, Medicare, Medicaid, Managed CareEducation/Experience:Bachelor's degree in related field or equivalent experience.2+ years of combined managed healthcare and provider reimbursement experience.Advanced knowledge of Microsoft Excel.Clinical or health information management (HIM) experience preferred.Claims processing and/or managed care experience preferred.Licenses/Certifications: Current state driver's license.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.Job SummaryJob number: 1288875Date posted : 2021-12-16Profession: Business Dev & SalesEmployment type: Both

Keywords: Centene, Seattle , Provider Network Specialist II, Other , Seattle, Washington

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