Network Relations Manager

• Act as the primary resource for assigned high-profile Medicaid providers and groups
• Establish, oversee, and maintain positive provider relationships
• Respond to complex issues involving Medicaid policies and procedures, plan design, contract language, service, claims, and compensation
• Monitor service capabilities and collaborate cross-functionally to resolve escalated claims, contract, and provider-information issues
• Support database management, contract coordination, and credentialing activities
• Educate Medicaid providers on contract policies, plan design, compensation processes, technology, policies, and procedures
• Meet regularly with key providers to ensure service levels meet expectations
• Develop agendas, validate materials, and facilitate external provider meetings
• Collaborate on implementation of large provider systems, cost initiatives, trend identification, and problem resolution
• Provide guidance and training to less experienced team members
• Collaborate with Provider Enablement & Strategy on provider-facing communications, workflows, external trainings, reporting needs, and HUB support
• Perform other duties as assigned

• Minimum 5 years' work experience in healthcare
• Minimum 3 years' experience in a Medicaid Managed Care business segment environment servicing providers
• Exposure to benefits and/or contract interpretation
• Working knowledge of business segment-specific codes, products, and terminology
• Ability to travel within the defined territory 50–80% of the time
• Must reside in Oklahoma
• Knowledge of Medicaid regulatory standards for network access, credentialing, claim lifecycle, provider appeals and disputes, and network performance standards
• Experience with medical terminology, CPT, ICD-10 codes, etc.
• Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills

Demonstrates extensive experience in Medicaid Managed Care, provider relationship management, and contract interpretation, with a strong focus on compliance with Medicaid regulatory standards and effective communication skills.

• Medicaid Managed Care Experience
• Provider Relationship Management
• Contract Interpretation
• Knowledge of Medicaid Regulatory Standards
• Medical Terminology Proficiency

• Database Management
• Contract Coordination
• Credentialing Activities
• CPT Codes
• ICD-10 Codes
• Claims Processing
• Service Level Monitoring
• Provider Education
• Problem Resolution
• Trend Identification

• Verbal Communication
• Written Communication
• Interpersonal Skills
• Critical Thinking
• Problem Resolution

• Healthcare
• Medicaid
• Provider Appeals
• Network Access
• Claim Lifecycle
• Network Performance Standards
• Provider Enablement
• External Training
• Workflows
• Reporting Needs