Provider Network Specialist, Behavioral Health job in Baton Rouge, Louisiana- Centene


You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Louisiana Healthcare Connections and Centene Corporation are hiring for a Behavioral Health, Provider Network Specialist II within or near the following parishes: East or West
Baton Rouge, Ascension, East and West
Feliciana, Pointe
Coupee, and Iberville. Once it is safe to do so, this role will see providers in these areas. 

As a PNS II you will be the face of the health plans to our providers. Highly qualified applicants should have behavioral health background, top notch communication skills, provider facing experience (which can include office managers, clinic support, billing managers, ect). Claims experience is a plus. If this is you, apply today!  

Additional responsibilities may include: 

  • 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 outreach
  • Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
  • Perform 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 factor.
  • Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
  • Provide information and status updates for providers regarding incentive agreements
  • Conduct site visits when required
  • Perform 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 project

Our Comprehensive Benefits Package:

  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  • Competitive pay
  • Paid Time Off including paid holidays
  • Health insurance coverage for you and dependents
  • 401(k) and stock purchase plans
  • Tuition reimbursement and best-in-class training and development

Key Words: Behavioral, Behavioral Health, Behave, Pay for Performance, P4P, Risk Adjustment, RA, Medicaid, Medicare, , Market Place, WellCare, Centene, Provider Performance Specialist, Medicare, Medicaid, Network, Networking,  Provider, Provider Relations, Network Contracting, Network Development, Healthcare, STARS, Medicaid, CHIP, Medicare Advantage, CMS Guidelines, Sales, Provider Connect, Provider Connection, Provider Data, Provider Affairs, Physician Liaison, Provider, Communications, Revenue Cycle, Revenue Analyst, Contract Specialist, Contract, Claims, Claims Billing, Revenue Cycle Support Representative, ROI, Physicians, Patients, Facilities, Configuration, Managed Care, MCO, provider reimbursement and analysis, Credentialing, Education 

Licenses/Certifications: Current state driver’s license.

  • Bachelor’s degree in related field or equivalent experience.
  • 2+ years of combined managed healthcare and provider reimbursement experience.
  • Advanced knowledge of Microsoft Excel.
  • Clinical or health information management (HIM) experience preferred.
  • 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.


Clipped from: