Provider Relations & Contracting Specialist II

Bachelor’s Degree in healthcare administration, business administration or equivalent experience
4+ years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid services environment
Current state driver’s license

Serve as contact for provider inquiries and track inquiries and response times
Draft contracts and manage contracting process to verify that contract deadlines are met
Monitor provider credentialing activities and contact providers for missing or incomplete information
Maintain and update provider databases to include key provider demographics and specialty provider information
Conduct administrative audits of provider agencies to evaluate provider contract adherence
Review, audit and price contract related pends to verify claims payment accuracy
Record, track, and monitor provider contract deliverables
Maintain the Provider Manual and update orientation materials as assigned
Conduct new provider orientation and train providers on the Provider Manual updates and State policy updates
Create and process Vendor Agreements and Single Case agreements as assigned
Lead department process improvement efforts and initiatives
Monitor financial performance of contracts
Serves as lead on projects as requested by department manager
Ability to travel
Performs other duties as assigned
Complies with all policies and standards

No preferred qualifications provided.