EGID Provider Contracting Specialist
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Job Location:
Oklahoma City, OK - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Job Posting Title
EGID Provider Contracting SpecialistAgency
807 HEALTH CARE AUTHORITYSupervisory Organization
EGIDJob Posting End Date
Refer to the date listed at the top of this posting if available. Continuous if date is blank.
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Estimated Appointment End Date (Continuous if Blank)
Full/Part-Time
Full timeJob Type
RegularCompensation
$22.81875 / hourlyWhy Youll Love Working Here
At the Oklahoma Health Care Authority (OHCA) your work matters. Every day our team helps ensure Oklahomans have access to better health and better care. Guided by our core values Passion for Purpose Trust & Transparency Empowerment & Accountability Best-in-Class Outcome-Driven and Servant Leadership we foster a workplace where people feel supported respected and empowered to make an impact. Learn more about OHCA.
Lets Talk Benefits
We know your great work deserves great support. Heres a snapshot of what we offer for all eligible employees.
Generous state-paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre-existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits including an on-site gym and fitness center discounts.
Job Description
Location: 4345 N Lincoln Blvd Oklahoma City OK 73105
Salary: $22.81875 per hour
Work Schedule: Monday Friday
Primary Hours: 8:00 a.m. 5:00 p.m.
Agency/Division Information
The Oklahoma Health Care Authority (OHCA)works to ensure Oklahomans have access to better health and better care.The agencys core values include passion for purpose trust and transparencyempowermentand accountability best in class and outcome-driven and servant leadership.As part of the interview process candidates maybe requiredto attend an in-person interview at our Oklahoma City office.
Position Purpose
The Provider Contracting Specialist Iis responsible formanaging provider contractsmaintainingprovider relationships and ensuring compliance with applicable regulations and policies. This role includes handling incoming and outgoing communicationsmaintainingaccurateprovider data and supporting provider network management activities to ensure efficient and effective service delivery.
PrincipalActivitiesMay Include:
Ensureaccurateandtimelymanagement of provider contracts including pricing NSA claims negotiating NSA requests and responding to independent dispute resolutions.
Foster strong working relationships with providers through effective communicationtimelyresponse to inquiries and proactive resolution of issues.
Adhere to HIPAA regulations OMES policies and other relevant statutes by protecting the privacy and confidentiality of program participants information.
Enter and review provider demographics accurately andtimely ensuring anaccuracyrate of 97% or better based on audits.
Handle incoming and outgoing calls emails and provider retention tasks whilemaintaininga customer service quality audit score of 85% or better.
Other duties as assigned.
Knowledge Skills Abilities and Competency Requirements
This position requires working knowledge of provider contracting principles within the health insurance or health care environment including Medicare guidelines reimbursement methodologies provider credentialing coding and contract terminology. The role demands strong organizational and communication skills to accurately manage provider data respond to inquiries support negotiations related to NSA claims andmaintaincompliance with HIPAA OMES policies and applicable regulations.Proficiencywith Microsoft Office and provider database systems is essential along with the ability to deliver consistent customer service and meet established quality and accuracy standards. Key Korn Ferry competencies for this role include Ensures Accountability reflecting the responsibility for data accuracy compliance and contract management; Communicates Effectively due to frequent interaction with providers and internal stakeholders; and Manages Complexity as the position requires navigating regulatory requirements contract provisions and reimbursement processes with precision.
**To be considered for this position your application must include a resume/CV with complete work and education history.**
Education and/or Experience:
Abachelors degree and1year of experience in health insurance benefit administration or health care industry provider contractingOR
An equivalent combination of education and experience.
Preference Qualifications Include:
Knowledge of Medicare guidelines policies and procedures.
Knowledge of provider licensing certification contractual issues reimbursement procedural coding benefitcoverageand liability requirements. Knowledgeregardingthese laws regulations and proceduresarecritical to the management of an effective Provider Network.
Knowledgeof provider database maintenance plan provisions agency policies provider types credentials management coding and reimbursement methods claims payment process and contract provisions/terminology.
Strong organizational skills.
Knowledge of large group network management and provider services to include provider enrollment and contracting verbal and written communication skills customer services and experience providing phone coverage provider recruitment training response to member and provider inquiries use of network database applications
Requires a detailed understanding of insurance plan provisions terms policies provider types credentials management coding and reimbursement methods claims payment processes contractprovisionsand terminology.
Knowledge of and ability to use Microsoft Office Applications.
Physical Demands and Work Environment
Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise the course of performing job duties employees are required to speak stand walk and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of the job.
Accommodation Statement:
The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race color sex religion disability age national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .
Notice to applicants:
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current State of Oklahoma employees must apply for open positions internally through WorkdayJobs Hub.
Equal Opportunity Employment
The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information race religion color sex age national origin or disability.
Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
If you are needing any extra assistance or have any questions relating to a job you have applied for please click the link below and find the agency for which you applied for additional information:
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
