Job description

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.

Position Purpose: Act as a liaison between providers and the health plan, including investigating and resolving critical provider claims issues, performing training and orientations, and coaching for performance improvement. Serve as the internal staff lead that will support the training of Account Managers and act as a resource to staff on issue resolution. Manage special projects that focus on efficiency and quality within Provider Relations. Ensure provider accounts are handled appropriately and consistently to provide optimal customer service.

Act as liaison between all contracts and company operating departments on critical or complex account issues.
Act as a lead to staff to help resolve problems or complaints identified by accounts and manage account issues to closure.
Lead in the project management of all contract implementations and in the establishment of strong account relationships while ensuring a smooth transition of services for members.
Support leadership with monitoring and tracking legislative or regulatory changes and issues for all areas of operation.
Translate ideas and client requests into actionable items for operations to enhance service delivery or new product offerings.
Provide support and strategic business insight about products and services to management, peers and clients.
Deliver in depth orientation, change communication and educational presentations to internal and external business partners.
Provide training to both internal and external partners on the use and function of the policies, processes, products, and services.
Coordinate the design, development and rollout of product enhancements and related projects as requested by clients.
Manage and maintain assigned high-level account and client relationships and service responsibilities.
Complete regularly scheduled and ad-hoc site visits, conference calls and vendor delegation meetings with all accounts.

Education/Experience: High school diploma or equivalent experience. Bachelor’s degree in healthcare related field preferred. Minimum 3+ years experience in provider relations, provider contracting; health plan operations or health care/medical office environment. Knowledge of health care, managed care, Medicare, Medicaid or commercial insurance products. Prior experience with data systems and Microsoft Office applications preferred.

Strongly prefer candidates with Wellcare familiarity, and experience supporting Nursing facilities and Long Term Care.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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