Location: Durham, NC
Position Description
Reporting to the Director of Business Operations/Provider Relations & Support, The Provider Support Coordinator is a member of the Provider Relations & Support Team serving as an operational liaison between Medicaid and Marketplace Healthcare Providers, Carolina Complete Health (CCH), Ambetter, Centene and CCHN.
Key Responsibilities
• Serve as the primary contact for Medicaid and Marketplace Healthcare Providers regarding operational and administrative questions and/or issues.
• Serve as a liaison between the Provider, the PHP and others.
• Investigate, resolve and communicate Provider questions, issues and/or changes
• Assist in educating Providers on CCH processes and operations
• Coordinate and negotiate contracts
• Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication
• Assist in developing and maintaining the healthcare provider network plan for the awarded regions.
• Assist in updating and maintaining the Provider CRM and contract database.
• Partner with the health plan contract team to ensure State compliance.
• Follow State mandated guidelines in relation to Provider Relations, Contracting and Medicaid Transformation.
• Must be available to work Monday through Friday and one Saturday per month between the hours of 9:00am - 6:00pm.
• Perform other duties as assigned
Preferred Qualifications
• High school diploma or equivalent.
• Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience.
• Experience in Microsoft Office to include Outlook, Excel and Sharepoint
• Experience in customer service, sales, provider relations, or contracting.
• Ability to handle multiple tasks at a time in a fast-paced environment
• Knowledge of healthcare, managed care, Marketplace, Medicare or Medicaid insurance.
• Current state driver’s license.