Offer summary

Qualifications:

Bachelor’s Degree in healthcare administration, business administration, or equivalent experience., 4+ years of provider relations or contracting experience in health care, managed care, Medicare, or Medicaid services environment., Strong understanding of provider manual and contract requirements., Current state driver’s license..

Key responsibilities:

Act as a liaison between providers, the health plan, and Corporate to resolve provider issues.

Conduct new provider orientations and educate providers on the provider manual and contract requirements.

Draft contracts, manage the contracting process, and monitor provider credentialing activities.

Lead department process improvement efforts and monitor financial performance of contracts.

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: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider issues. Perform new provider orientations and educate providers regarding the provider manual, and contract requirements. Serves as a resource for department staff and provides training as need.

Serve as contact for provider inquires and track inquiries and response times.
Draft contracts and manage contracting process to verify that contract deadlines are met
Monitor provider credentialing activities and contact providers for missing or incomplete information
Maintain and update provider databases to include key provider demographics and specialty provider information
Conduct administrative audits of provider agencies to evaluate provider contract adherence
Review, audit and price contract related pends to verify claims payment accuracy
Record, track, and monitor provider contract deliverables
Maintain the Provider Manual and update orientation materials as assigned.
Conduct new provider orientation and train providers on the Provider Manual updates and State policy updates
Create and process Vendor Agreements and Single Case agreements as assigned
Lead department process improvement efforts and initiatives
Monitor financial performance of contracts.
Serves as lead on projects as requested by department manager.
Ability to travel
Performs other duties as assigned
Complies with all policies and standards

Education/Experience: Bachelor’s Degree in healthcare administration, business administration or equivalent experience. 4+ years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid services environment.

Licenses/Certifications: Current state driver’s license.

This position is remote within the state of California, with onsite meetings required.

Pay Range: $26.50 - $47.59 per hour

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

Required profile