Provider Contracts Analyst III

Oklahoma State Government•Oklahoma City, OK

4d•$25•Onsite

About The Position

The Provider Contracts Analyst III plays a key role in supporting the Oklahoma Health Care Authority’s (OHCA) mission by independently handling complex provider inquiries, resolving contractual issues, and ensuring compliance with OHCA policies and federal/state regulations. This position involves managing provider contracts, maintaining database integrity, and providing accurate information and training to providers. The role is essential in fostering strong provider relationships, coordinating with various departments to address system challenges, and ensuring timely and efficient provider enrollment and credentialing processes. Additionally, the Analyst contributes to continuous improvement in provider engagement and support, while upholding the agency’s core values of accountability, transparency, and outcome-driven excellence.

Requirements

1 year of experience in clerical office work or as a customer service representative plus 3 years of experience in customer service, processing tax returns, bookkeeping or closely related work
An equivalent combination of education and experience, substituting 30 semester hours of college, including 6 semester hours in business or public administration for the required experience plus 3 years of experience in customer service, processing tax returns, bookkeeping or closely related work.
In-depth knowledge of OHCA policies, state and federal legislation, and principles of program administration, along with strong problem-solving abilities to resolve complex provider issues.
Advanced communication and organizational skills to coordinate across divisions and manage provider relationships.
Decision Quality (ability to make sound decisions in complex situations) and Customer Focus ( maintaining a strong commitment to addressing provider needs and ensuring satisfaction).

Nice To Haves

Certifications in any of the following areas: Certified Contract Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), Certified Public Manager (CPM), Certified Provider Credentialing Specialist (CPCS), Project Management Professional (PMP), or Lean Six Sigma Certification
Experience with Medicaid/Medicare Regulations

Responsibilities

Answers complex incoming telephone and written inquiries from providers, requiring individual research.
Independently analyzes, investigates, and resolves complex inquiries and complaints from providers in a timely manner .
Identifies potential operational and contractual issues, communicates, and resolves issues with providers and participates in the formulation of procedures to resolve conflicts.
Coordinates with appropriate departments to resolve system problems and develop timely solutions.
Determines eligibility, verifies and enters data, and resolves issues related to enrollment.
Maintains provider database integrity and ensures compliance with system, legal, and policy requirements for provider contracts.
Participates in the OHCA provider call center, answering a wide variety of questions and resolving problems related to contract requirements, licensing, and electronic funds transfer.
Provides provider training and keeps updated on OHCA/ SoonerCare policies to provide accurate information to providers.
Screens potential providers through databases and advances provider applications, maintaining timelines on enrollment and credentialing schedules.
Other duties as assigned.