33 jobs found in lumberton

Position Purpose: This is a remote position with the ability to travel in the Lumberton, NC area. Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution. Serve as primary contact for providers and act as a liaison between the providers and the health plan Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution Receive and effectively respond to external provider related issues Provide education on health plan's innovative contracting strategies Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network Investigate, resolve and communicate provider...

Position Purpose: Develop and maintain collaborative relationships with Health & Family Services, government agencies, community resource and advocacy groups, to build additional community support for current and potential members. Identify and develop relationships with key community stakeholders throughout market region and act as the liaison between these organization and the health plan Collaborate with stakeholders and community-based organizations to facilitate the development of community partnerships and assist in the translation of partnerships into operational strategies Identify opportunities for partnering with community, provider, and advocacy organizations to establish stronger and visible relationships with various constituencies Monitor and report on achievement of committed action plans Facilitate and maintain communication between internal and external audiences Coordinate outreach activities to identify enrollees needing care within various...

Position Purpose: Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA)...