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Provider Network Specialist II
OMAHA NE 68132
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-85755465

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Centene Corporation

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  Job posted:   Tue Mar 13, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Provider Network Specialist II
ProfessionalPosition Purpose: Perform health plan 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.Conduct initial provider orientations as well as ongoing educational outreachEducate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data InterfaceEnhance 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 initiativesPerform 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 factorsCreate and communicate milestone documents, dashboards and success or improvement metricsAct as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performanceProvide information and status updates for providers regarding incentive agreementsConduct site visits when requiredPerform 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 projectsAbility to travel

TITLE: Provider Network Specialist II

LOCATION: Omaha, Nebraska

REQNUMBER: 1091718

COMPANY: Network Development & Contracting

POSITION TYPE: Professional

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