EGID Provider Relations Specialist

Job Posting

Title:

EGID Provider Relations Specialist

Agency: 807 HEALTH CARE AUTHORITY

Supervisory Organization: EGID

Job Type: Regular Full time

Compensation: $22.81875 per hour

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Work Schedule: Monday – Friday, 8:00 a.m. – 5:00 p.m.

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values—Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership—we foster a workplace where people feel supported, respected, and empowered to make an impact.

• Generous state‑paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre‑existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on‑site gym and fitness center discounts.

The Provider Relations Specialist is responsible for provider communications and directories, reimbursement, escalations, ensuring compliance with various regulations and rules, and providing exceptional customer service through effective communication and problem‑solving skills. This role is essential for maintaining the accuracy and integrity of provider information and supporting the overall efficiency of the Network Management team.

• Manage provider communications, update provider directories, and ensure accuracy and timeliness of information.
• Conduct monthly provider directory audits, handle inactive provider terminations, and compile statutorily required reports.
• Respond to provider emails and phone calls, maintain a high level of customer service, and participate in recruitments.
• Maintain SharePoint site, monitor unit reports, communicate and assist with reimbursement and fee schedules, and assist in the development and implementation of business reports and project plans.
• Other duties as assigned.

The position requires strong analytical and communication skills to manage provider communications, maintain accurate directories, and respond to provider inquiries with a high level of customer service. Knowledge of healthcare reimbursement practices, claims processing, insurance regulations, and benefit plan administration is essential. Proficiency in Microsoft Office, especially Excel and SharePoint, and familiarity with health care terminology and compliance requirements are critical.

Success hinges on the ability to interpret complex regulations, manage detailed data sets, and support cross‑functional initiatives. Kern Ferry competencies most relevant are Ensures Accountability, Customer Focus, and Optimizes Work Processes.

• Must include a resume/CV with complete work and education history.

• A bachelor’s degree and two years of experience in health insurance benefit administration or health care industry provider contracting.

or

• An equivalent combination of education and experience.

• Knowledge of Microsoft Office with fundamental Excel functions, VBA, and working with large data sets.
• Knowledge of state and federal laws and regulations pertaining to various types of health and dental benefit plans and federally mandated programs, including CMS‑Medicare guidelines.
• Knowledge of medical and dental markets, insurance & contracting terminology, practices, and process controls.
• Knowledge of Medicare and commercial reimbursement methodologies and related coding systems.
• Knowledge of claims processing systems and guidelines.
• Knowledge of and experience with the No Surprises Act.
• Knowledge of insurance plan related administrative procedures.

Work is performed in an office setting with…