Provider Engagement Account Manager
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Mississippi • United States
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Salary
💰 $56,200 - $101,000 per year
About the role
- Maintain partnerships between the health plan and the contracted provider networks serving our communities.
- Build client relations to ensure delivery of the highest level of care to our members.
- Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution.
- Drive optimal performance in contract incentive performance, quality, and cost utilization.
- 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.
- Completes special projects as assigned.
Requirements
- Bachelor’s degree in related field or equivalent experience.
- Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
- Project management experience at a medical group, IPA, or health plan setting.
- Proficient in HEDIS/Quality measures, cost and utilization.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data entryprovider performance evaluationquality improvementclaims managementcontractingutilization managementproject managementHEDIScost utilization
Soft Skills
client relationsconsultative account managementissue resolutioncommunicationeducationtriageproblem-solving
Certifications
Bachelor’s degree