Michigan IT Jobs

Mobile michigan-jobbank Logo

Job Information

Centene Corporation Provider Network Specialist II in Saginaw, Michigan

Centene believes 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.

This is a field-base position, as you will be meeting with our Providers (once it is safe to do so). Qualified applicants must be willing to be field based and cover the Central to Western counties of Michigan.

As a Provider Network Specialist II you will be the face of our health plan. You will perform provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship. Additional duties and responsibilities include the following:

  • Conduct initial provider orientations as well as ongoing educational outreach

  • Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface

  • Enhance 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 initiatives

  • Perform 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 factors

  • Create and communicate milestone documents, dashboards and success or improvement metrics

  • Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance

  • Provide information and status updates for providers regarding incentive agreements

  • Conduct site visits when required

  • Perform 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 projects

  • Ability to travel

Key Words: Provider Network, Provider Liaison, Network Coordinator, Network Representative, STARS, Provider Groups, Reimbursement, Analyst, Provider Education, Educate, Healthcare, Engagement, Manager, Claims

This is a field-base position, as you will be meeting with our Providers (once it is safe to do so). Qualified applicants must be willing to be field based and cover the Central to Western counties of Michigan.

Highly Qualified Candidates will also have experience with Claims/Claims Processing and have been in a Provider facing role previously.

Education/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.

TITLE: Provider Network Specialist II

LOCATION: Saginaw, Michigan

REQNUMBER: 1220976

COMPANY: Business Dev & Sales

POSITION TYPE: Both

DirectEmployers