Jobs for Humanity is partnering with Centene Medicare to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located.

Company Name: Centene Medicare

Join our team and make a difference in the lives of our 28 million members. Centene is dedicated to improving the health of our communities, one person at a time. As a national organization that embraces diversity, we offer competitive benefits and a flexible work environment.

Position Purpose: Be the bridge between Tier III and Tier IV providers (small to medium PCP groups and providers with upside only incentives) and the health plan. Manage network performance for assigned territory, using a consultative approach. Help providers improve their performance in areas such as Risk/P4Q, quality, cost, and utilization. Evaluate provider performance and create strategic plans for improvement. Support providers through trainings and claim resolution.

• Act as the main point of contact for providers and facilitate communication with the health plan
• Resolve provider issues by working with internal partners
• Address external provider-related concerns
• Investigate, resolve, and communicate provider claim issues and updates
• Update provider information in our system
• Educate providers on policies and procedures related to referrals, claims submission, website usage, and more
• Conduct provider orientations and ongoing education sessions
• Manage network performance using a consultative approach
• Evaluate provider performance and develop plans for improvement
• Drive improvement in areas like Risk/P4Q, quality, cost, and utilization
• Complete assigned special projects
• Ability to travel locally 4 days a week

Education/Experience: Bachelor’s degree in a related field or equivalent experience. 0-2 years of experience in provider relations, provider claims/reimbursement, or contracting. Knowledge of healthcare, managed care, Medicare, or Medicaid preferred. Bachelor's degree in healthcare or a related field is a plus. Familiarity with claims billing/coding is preferred.

Our Comprehensive Benefits Package: We offer flexible work options, including remote opportunities and hybrid schedules. Competitive pay, Paid time off, including holidays. Health insurance coverage for you and your dependents. 401(k) and stock purchase plans. Tuition reimbursement and top-notch training and development opportunities.

Centene is an equal opportunity employer that values diversity and appreciates our unique qualities. We welcome applicants from all backgrounds, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.