Provider Field Representative I
About The Position
The Provider Field Representative I supports New Hampshire Medicaid providers by resolving routine inquiries, delivering MMIS portal guidance, and helping ensure provider satisfaction, operational accuracy, and program compliance. This role performs routine provider support and Medicaid operations activities using established processes and procedures. It involves developing job knowledge and skills through hands-on experience, training, and collaboration with providers and internal teams. The representative resolves standard provider inquiries and issues with guidance from leadership and experienced team members, supporting provider satisfaction, operational excellence, and program compliance.
Requirements
- A minimum of three (3) years of experience in healthcare operations, Medicaid programs, provider relations, claims processing, customer service, or technical program support.
- Minimum of one (1) year of training development, facilitation, or provider education experience.
- Strong analytical, problem-solving, critical thinking and customer service skills.
- Excellent verbal and written communication skills.
- Proficiency with Microsoft 365 applications, including Outlook, Word, Excel, PowerPoint, and Teams.
- Ability to manage multiple priorities and work effectively in a fast-paced environment.
Nice To Haves
- Knowledge of New Hampshire Medicaid policies, provider enrollment processes, claims adjudication, and reimbursement methodologies.
- Experience using Medicaid Management Information Systems (MMIS) or similar healthcare systems.
- Understanding of provider billing practices, healthcare regulations, and Medicaid program requirements.
- Experience supporting healthcare providers through training, outreach, or account management activities.
- Have an associate’s degree.
Responsibilities
- Serve as a primary point of contact for New Hampshire Medicaid providers regarding claims, enrollment, billing, and MMIS portal inquiries.
- Build and maintain positive working relationships with providers, state partners, and client stakeholders.
- Conduct provider training on MMIS portal functionality, including claims submission, eligibility verification, enrollment and revalidation activities, and reporting tools.
- Act as a liaison between providers, operations teams, and state partners to facilitate issue resolution and ensure adherence to established processes.
- Research, troubleshoot, and resolve routine provider issues related to claims processing, provider enrollment and revalidation, portal access and navigation, billing inquiries, and policy guidance.
- Escalate complex issues appropriately and follow through to resolution.
- Support provider outreach initiatives, operational improvements, and special projects as assigned.
- Assist in resolving provider concerns, disputes, and service-related issues in a professional and timely manner.
- Apply working knowledge of Medicaid operations, provider relations, and healthcare business practices to support program objectives.
- Analyze information, policies, and procedures to make sound recommendations and decisions within established guidelines.
- Communicate effectively with internal and external stakeholders, ensuring accurate and consistent information is provided.
- Maintain compliance with contractual requirements, state regulations, organizational policies, and operational standards.
- Perform other duties as assigned.
Benefits
- Health and Welfare Benefits
- Retirement Savings
- Employee Discounts
- Career Growth Opportunities
- Paid Training
- Paid time off
- health insurance coverage
- voluntary dental and vision programs
- life and disability insurance
- a retirement savings plan
- paid holidays
- paid time off (PTO) or vacation and/or sick time
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
