Provider Contracts Analyst IV

State of Oklahoma•Oklahoma City, OK

6d•Onsite

About The Position

The Provider Contracts Analyst IV is responsible for providing strategic oversight and leadership in managing provider contracts and ensuring compliance with regulatory requirements. This position involves screening potential providers, processing data changes, and monitoring licensure to maintain database integrity. Additionally, the role supports complex contracting inquiries, identifies areas for improvement, and ensures the effectiveness of contracting processes. As a key point of contact and team leader, the Provider Contracts Analyst IV mentors staff and collaborates with internal and external stakeholders to meet the agency's operational and strategic goals.

Requirements

A bachelor's degree and 1 year of professional or technical administrative experience in business or public administration OR An equivalent combination of education and experience, substituting 1 year of qualifying experience for each year of the required education.
Technical administrative experience would include highly complex clerical work gained under the direct supervision of a professional supervisor or manager.
In-depth knowledge of agency policies, state and federal legislation, and principles of program administration.
Strong skills in communication, problem-solving, and collaboration.
Ability to manage multiple priorities, provide leadership, and align programs with broader organizational goals.
Ensures Accountability and Manages Complexity competencies.

Nice To Haves

Certifications in any of the following areas: Certified Provider Credentialing Specialist (CPCS), Certified Healthcare Contracting Professional (CHCP), Project Management Professional (PMP), Lean Six Sigma Green Belt or Black Belt, Compliance Certification
Legal or Regulatory Licenses
Experience in Medicaid/Medicare Regulations

Responsibilities

Oversees complex provider contract administration activities to ensure compliance with OHCA policies, Medicaid regulations, and contractual requirements.
Serves as a lead resource for complex provider contracting issues, escalations, and inquiries requiring advanced policy interpretation or coordination across divisions.
Reviews and resolves complex provider enrollment, credentialing, and contract issues while ensuring accuracy and timeliness of provider records.
Monitors provider licensure, contract status, and enrollment data to ensure compliance with state and federal requirements and maintain database integrity.
Coordinates with internal teams such as policy, IT/system support, and operations to resolve systemic contracting or enrollment issues.
Provides guidance and technical support to Provider Contracts Analysts and other staff on contracting procedures, provider policies, and system processes.
Assists in developing and updating procedures, training materials, and standard operating documentation related to provider contracting activities.
Evaluates contracting workflows and operational processes to identify inefficiencies, compliance risks, or opportunities for improvement.
Participates in implementing process improvements, system updates, or policy changes that affect provider contracting and enrollment operations.
Tracks and analyzes trends in provider inquiries, contract issues, or operational challenges and provides feedback or recommendations to leadership.
Serves as a point of contact for internal stakeholders and external partners regarding complex provider contracting matters.
Other duties as assigned.