108 Healthcare jobs in Camden
Healthcare Provider Account Manager
Posted 5 days ago
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Job Description
Join Centene and be a pivotal part of transforming healthcare for our 28 million members! As a diversified national organization, we offer competitive benefits and a fresh perspective on workplace flexibility.
Position Purpose: Foster valuable partnerships between our health plan and the provider networks to ensure the highest standard of care for our members. Engage with providers to identify performance opportunities, drive solutions, and hold accountability for issue resolution while enhancing contract incentive performance, quality, and cost utilization.
- Act as the primary contact for providers, liaising between them and the health plan.
- Address and triage provider issues in collaboration with internal partners.
- Respond efficiently to external provider-related inquiries.
- Investigate, resolve, and communicate provider claim issues and procedural changes.
- Manage data entry for provider demographic information updates.
- Educate providers on policies and procedures regarding referrals, claims submission, website usage, and EDI processes.
- Conduct provider orientations and provide ongoing education through the development and revision of orientation materials.
- Oversee network performance in assigned territories through a consultative management approach.
- Evaluate provider performance and create strategic plans for improvement.
- Drive enhancements in provider performance areas including Risk/P4Q, Health Benefit Ratio (HBR), HEDIS quality measures, and cost/utilization metrics.
- Complete special projects as assigned.
- Willingness to travel locally up to four days per week.
- Perform other duties as assigned and comply with all policies and standards.
Education/Experience: A bachelor's degree in a related field or equivalent experience is required. Candidates should have two years of experience in managed care, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations. Project management experience in a medical group, IPA, or health plan setting is essential.
Proficiency in HEDIS/Quality measures, cost, and utilization is also required.
Generous pay range: $55,100.00 - $99,000.00 per year.
Centene provides a comprehensive benefits package, including competitive pay, health insurance, a 401K plan, stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work options (remote, hybrid, field, or office). Compensation will be based on individual skills, experience, education, and other job-related factors as permitted by law. Additional incentives may also be part of the total compensation package.
As an equal opportunity employer, Centene values diversity and is committed to creating an inclusive environment for all. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any 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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