Provider Field Representative

Conduent

About The Position

Performs routine and structured assignments related to provider support and Medicaid operations. This role involves developing skills through hands-on work with providers, systems, and internal teams, and using established procedures to resolve routine or standard provider inquiries. The incumbent will receive instruction, guidance, and direction from more experienced team members or leadership. This position serves as a primary point of escalation contact for NH Medicaid providers regarding claims, enrollment, billing, and portal-related inquiries, building and maintaining strong, positive relationships with providers and the client to support program success. It assists in overall business unit performance by supporting provider satisfaction and operational accuracy, and ensures adherence to best practices and compliance with NH Medicaid policies and the Statement of Work.

Requirements

College degree or equivalent work experience required, with exposure to healthcare operations, Medicaid programs, or related concepts.
Requires relevant expertise in Medicaid operations, provider relations, claims processes, or technical program support, gained through formal education or equivalent experience.

Nice To Haves

Requires a conceptual understanding of NH Medicaid policies, claims processes, provider enrollment procedures, and MMIS portal functionality.
Understands provider types, billing practices, and Medicaid program requirements.

Responsibilities

Serves as a primary point of escalation contact for NH Medicaid providers regarding claims, enrollment, billing, and portal-related inquiries.
Builds and maintains strong, positive relationships with providers and the client to support program success.
Assists in overall business unit performance by supporting provider satisfaction and operational accuracy.
Ensures adherence to best practices and compliance with NH Medicaid policies and the Statement of Work.
Conducts MMIS portal training for providers, including navigation, claims submission, eligibility verification, and reporting tools.
Acts as a liaison between providers, operations, and state partners to ensure protocols are followed and issues are resolved.
Supports conflict resolution related to provider concerns, claims disputes, or enrollment challenges.
Manages provider, system, and task-related issues with professionalism and accuracy.
Provides resolutions for a diverse range of tasks, including: Claims troubleshooting, Enrollment and revalidation support, Portal access and technical guidance, Policy clarification, Special projects, Urgent provider needs.
Drives special projects for operational, state, or provider initiatives.
Performs other duties as assigned.
Complies with organizational policies, state requirements, and operational standards.
Applies knowledge of NH Medicaid operations, provider relations, and healthcare business practices gained through education or prior experience.
Understands how provider performance and compliance impact program outcomes.
Uses established procedures to resolve standard provider issues related to claims, enrollment, billing, and portal access.
Examines information, policies, and standard practices to make sound judgments and escalate issues appropriately.
Communicates clearly and professionally with providers, internal teams, and state partners.
Builds and maintains positive working relationships with providers and the client.
Exchanges information and ideas effectively.
Asks clarifying questions and checks for understanding to ensure accurate guidance.