Position Summary
Reporting to the Provider Relations Manager, the Provider Relations 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 between the hours of 7:00am - 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