Provider Network Contract Representative

Amerihealth Caritas Health Plan • Harrisburg, PA

196d • Hybrid

About The Position

The Provider Network Contract Representative oversees the daily operations related to Out of Network (OON) agreements, provider contracts, and Supplemental Medical Assistance Enrollment applications. This role ensures the timely and accurate processing of provider agreements and supplemental packets, maintains detailed records, and supports providers through complex enrollment and documentation processes. The Specialist liaises between providers and internal departments such as Credentialing, Clinical, Member Services, and Provider Maintenance, ensuring compliance with state regulations and internal standards. A strong understanding of Medicaid, Medicare, and state-funded programs is essential, along with the ability to multitask, communicate effectively, and resolve issues efficiently.

Requirements

• High School Diploma or GED required.
• Minimum of 2 years of experience in a Behavioral Health or Managed Care environment, with direct provider interaction.

Nice To Haves

• An associate's degree in business administration, communication, or a related field is preferred.
• Experience in customer service, demonstrating strong communication and problem-solving skills.

Responsibilities

• Ensure timely distribution and accurate documentation of provider contracts and supplemental packets.
• Submit provider agreements and enrollment information to Credentialing, Account Executive (AE), and Provider Maintenance departments.
• Maintain expert knowledge of Medical Assistance enrollment types and CPT code requirements by provider specialty.
• Assist providers in completing supplemental packets and OON documentation in compliance with state regulations.
• Monitor and manage EXP workflow for OON requests, ensuring turnaround times meet PerformCare standards.
• Act as a liaison between providers and the Office of Mental Health & Substance Abuse Services (OMHSAS), supporting Medicaid enrollment and documentation processes.
• Coordinate with internal departments to ensure accurate provider setup in systems and proper claims payment.
• Adhere to all organizational policies, including confidentiality, compliance, and fraud prevention protocols.

Benefits

• Flexible work solutions including remote options, hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees