Provider Field Representative

General Profile

• Performs routine and structured assignments related to provider support and Medicaid operations.
• Develops skills through handson work with providers systems and internal teams.
• Uses established procedures to resolve routine or standard provider inquiries.
• Receives instruction guidance and direction from more experienced team members or leadership.

Responsibility Statements

• Serves as a primary point of escalation contact for NH Medicaid providers regarding claims enrollment billing and portal-related inquiries.
• Builds and maintains strong positive relationships with providers and the client to support program success.
• Assists in overall business unit performance by supporting provider satisfaction and operational accuracy.
• Ensures adherence to best practices and compliance with NH Medicaid policies and the Statement of Work.
• Conducts MMIS portal training for providers including navigation claims submission eligibility verification and reporting tools.
• Acts as a liaison between providers operations and state partners to ensure protocols are followed and issues are resolved.
• Supports conflict resolution related to provider concerns claims disputes or enrollment challenges.
• Manages provider system and task-related issues with professionalism and accuracy.
• Provides resolutions for a diverse range of tasks including:
  • Claims troubleshooting
  • Enrollment and revalidation support
  • Portal access and technical guidance
  • Policy clarification
  • Special projects
  • Urgent provider needs
• Drives special projects for operational state or provider initiatives.
• Performs other duties as assigned.
• Complies with organizational policies state requirements and operational standards.
• Applies knowledge of NH Medicaid operations provider relations and healthcare business practices gained through education or prior experience.
• Understands how provider performance and compliance impact program outcomes.
• Uses established procedures to resolve standard provider issues related to claims enrollment billing and portal access.
• Examines information policies and standard practices to make sound judgments and escalate issues appropriately.
• Communicates clearly and professionally with providers internal teams and state partners.
• Builds and maintains positive working relationships with providers and the client.
• Exchanges information and ideas effectively.
• Asks clarifying questions and checks for understanding to ensure accurate guidance.

REQUIREMENTS

• College degree or equivalent work experience required with exposure to healthcare operations Medicaid programs or related concepts.
• Requires relevant expertise in Medicaid operations provider relations claims processes or technical program support gained through formal education or equivalent experience.

Additional Skills preferred:

• Requires a conceptual understanding of NH Medicaid policies claims processes provider enrollment procedures and MMIS portal functionality.
• Understands provider types billing practices and Medicaid program requirements.

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position actual salaries will vary and may be above or below the range based on various factors including but not limited to location experience and addition to base pay this position based on business need may be eligible for a bonus or addition Conduent provides a variety of benefits to employees including health insurance coverage voluntary dental and vision programs life and disability insurance a retirement savings plan paid holidays and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $58000-$65000