Provider Contract Specialist - Hybrid

Responsibilities

• Aid providers in resolving contract disputes and ensure accurate contract and rate load implementations.
• Communicate with providers and respond to inquiries in a timely, accurate, and professional manner.
• Support the timely completion/coordination of claim inquiries and complaints for the Hospital, Ancillary, and/or Professional network.
• Coordinate Joint Operating Committees (JOCs), claim review and resolution, and support of audits when needed.
• Assist participating providers with issues requiring coordination of various Plan departments.
• Provide timely, useful, and accurate responses to provider requests.
• Ensure and coordinate notification and education of various departments within the EH on contract terms and related issues.
• Coordinate delegated credentialing functions and activities.
• Ensure the accuracy of provider demographic data in the Plan’s database.
• May recruit available providers to fulfill Network deficiencies.
• Perform outreach projects as needed.
• Document all outreach activities in compliance with department standards.
• Perform additional duties as directed, assigned, or required.

Qualifications

• Bachelor’s degree in health care - related field, Public Administration, Management, or equivalent
• 3 – 5+ years of direct provider relations experience
• Knowledge of provider and payor roles, responsibilities and challenges
• An understanding of health care financing, access issues, delivery systems, quality controls, and legislation
• Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff
• Ability to work well with various Plan departments
• Excellent communication skills, written and verbal
• Time management skills and flexibility to work on multiple projects/assignments simultaneously
• Willingness to assume diverse duties and challenges
• Interpersonal skills to effectively maintain working relationships
• Ability to work independently and maximize opportunities to support
• Analytical and problem-solving skills to identify needs in provider relationships, make recommendations, and follow through to resolution
• Proficiency in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.