EGID Provider Contracting Specialist

Oklahoma State Government•Oklahoma City, OK

11d•$23•Onsite

About The Position

The Provider Contracting Specialist I is responsible for managing provider contracts, maintaining provider relationships, and ensuring compliance with applicable regulations and policies. This role includes handling incoming and outgoing communications, maintaining accurate provider data, and supporting provider network management activities to ensure efficient and effective service delivery.

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, and maintain compliance with HIPAA, OMES policies, and applicable regulations.
Proficiency with 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.
A bachelor’s degree and 1 year of experience in health insurance benefit administration or health care industry provider contracting OR An equivalent combination of education and experience.

Nice To Haves

Knowledge of Medicare guidelines policies and procedures.
Knowledge of provider licensing, certification, contractual issues, reimbursement, procedural coding, benefit coverage and liability requirements.
Knowledge regarding these laws, regulations and procedures are critical to the management of an effective Provider Network.
Knowledge of 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, contract provisions and terminology.
Knowledge of and ability to use Microsoft Office Applications.

Responsibilities

Ensure accurate and timely management of provider contracts, including pricing NSA claims, negotiating NSA requests, and responding to independent dispute resolutions.
Foster strong working relationships with providers through effective communication, timely response 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 and timely , ensuring an accuracy rate of 97% or better based on audits.
Handle incoming and outgoing calls, emails, and provider retention tasks while maintaining a customer service quality audit score of 85% or better.
Other duties as assigned.