Provider Contracting Specialist

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.

The Provider Contracting Specialistis responsible formanaging providercontractsmaintainingprovider relationships and ensuring compliance with applicableregulations and policies. This role includes handling incoming and outgoingcommunicationsmaintainingaccurateprovider data and supporting provider networkmanagement activities to ensure efficient and effective service delivery.

• 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 an accuracy rate 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.

• Abachelors degree and2years of experience in health insurance benefit administration or health care industry provider contractingOR

• An equivalent combination of education and experience.

• 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 policiesprovider types credentials management coding and reimbursement methods claims payment processes contractprovisionsand terminology.

• Knowledge of and ability to use Microsoft Office Applications.

Work is typically performed in an office setting with climate-controlled settings and exposure tomoderate noise levels.In the course ofperforming job duties employeesare required tospeak 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 this position.

The Oklahoma Health Care Authoritycomplies withapplicable 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. Ifa reasonableaccommodation is needed toparticipatein 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:

Please add to the address book or safe-senders list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application you can contact the HR team at .

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.