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Provider Performance Specialist II, San Antonio, Texas

CategoryHealth Insurance Operations
Job typeFull Time
CountryUnited States of America
CitySan Antonio
Position Purpose:

  • Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results
  • Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting
  • Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions
  • Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data
  • Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings

  • Qualifications:

    Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.

    Bachelor's degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Claims processing and/or managed care experience preferred

    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.
    EmployerCentene Corporation

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