EGID Provider Relations Specialist

Oklahoma State Government • Oklahoma City, OK

5d • $23 • Onsite

About The Position

The Provider Relations Specialist is responsible for provider communications and directories, reimbursement, escalations, ensuring compliance with various regulations and rules, and providing exceptional customer service through effective communication and problem-solving skills. This role is essential in maintaining the accuracy and integrity of provider information and supporting the overall efficiency of the Network Management team.

Requirements

• The Provider Relations Specialist role requires strong analytical and communication skills to manage provider communications, maintain accurate directories, and respond to provider inquiries with a high level of customer service.
• The position demands knowledge of healthcare reimbursement practices, claims processing, insurance regulations, and benefit plan administration.
• Proficiency in Microsoft Office, particularly Excel and SharePoint, and familiarity with health care terminology and compliance requirements are essential.
• Success in this role hinges on the ability to interpret complex regulations, manage detailed data sets, and support cross-functional initiatives.
• A bachelor’s degree and 2 years of experience in health insurance benefit administration or health care industry provider contracting OR An equivalent combination of education and experience.
• To be considered for this position your application must include a resume/CV with complete work and education history.

Nice To Haves

• Knowledge of Microsoft Office with a fundamental knowledge of Excel functions, Visual Basic for Applications (VBA) and working with large data sets in various applications.
• Knowledge of state and federal laws and regulations pertaining to various types of health and dental benefit plans and federally mandated programs, including CMS-Medicare guidelines.
• Knowledge of medical and dental markets, insurance & contracting terminology, practices, and process controls.
• Knowledge of Medicare and commercial reimbursement methodologies and related coding systems.
• Knowledge of claims processing systems and guidelines.
• Knowledge of and experience with the No Surprises Act.
• Knowledge of insurance plan related administrative procedures.

Responsibilities

• Manage provider communications, update provider directories, and ensure accuracy and timeliness of information.
• Conduct monthly provider directory audits, handle inactive provider terminations, and compile statutorily required reports.
• Respond to provider emails and phone calls, maintain a high level of customer service, and recruitments.
• Maintain SharePoint site, monitor unit reports, communicate and assist with reimbursement and fee schedules, and assist in the development and implementation of business reports and project plans.
• Other duties as assigned.

Benefits

• 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.
• Retirement Savings Plan with employer contributions.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level