Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider physician injectable claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome.
Bachelor’s degree in healthcare related field preferred. 3-5 years of combined public relations and pharmacy related experience. Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license. CPhT license preferred.
•Serve as primary contact for providers serving as a liaison between the provider and the health plan for all pharmacy concerns
•Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution
•Receive and respond to provider related issues
•Recommend changes in pricing subsystems
•Attend weekly meetings with Case Management to assist where needed with pharmacy or medication concerns
•Educate providers regarding policies and procedures related to pharmacy issues; web site education, and problem solving (liaison responsibilities)
•Perform Provider orientations (includes writing/updating orientation material when necessary)
•Must have a good driving record and the ability to travel.
Centene Corporation - 19 months ago
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...