Medicaid Provider Relations Rep II
$54,668–$68,341 year
On-sitePortland, Oregon, United States
Job Summary
Concierge customer service to providers by acting as the liaison between Medicaid plans, presenting, promoting, and resolving concerns and issues brought forward by providers and internal staff. Draft communications, frequently asked questions, and resource guides to support network needs while developing, improving, and streamlining existing provider policies to remove barriers to care. Conduct face-to-face trainings for contracted providers, educate them on Oregon Administrative Rules and contract language, and coordinate targeted provider meetings including annual workshops. Validate bi-annual Delivery System Network reports, assist with state and federal audits, and identify root causes of claim problems to develop solutions. Process provider enrollment applications, complete Medicaid encounter data, and perform on-site visits to foster strategic partnerships. Provide timely responses to inquiries within two to three business days and represent the organization at outside meetings and conferences.
Required Qualifications
- Three or more years of provider relations experience
- Expertise in industry practices, specialized payment methodologies, Value Based Care agreements, Payer/Provider Strategic Partnerships, and all relevant regulations
- College degree in health care, business, analytics, or related field, or equivalent work experience
- Knowledge of Medicaid claims and benefits
- Proficiency in identifying and interpreting Oregon Administrative Rules, CCO and provider contracts
- Knowledge of provider payment methodologies including capitation, DRG, CAH and other facility and professional pricing
- Ability to analyze and validate provider claims and payment data
- Experience in manual processing of high dollar checks
- Judgement, self-motivation, and the ability to work independently, and as part of a team
- Detail oriented and possess strong analytical, and problem-solving skills
- Skilled at delivering trainings and facilitating meetings
- Strong interpersonal communication skills and the ability to develop effective relationship with network providers, members, and partners
- Proficiency in Microsoft Word, Excel, and PowerPoint
- Ability to work well under pressure with frequent interruptions and shifting priorities
- Must be willing to travel for provider training sessions
- Knowledge of Oregon's Coordinated Care Organization (CCO) Infrastructure
- Must be able to represent the organizations at outside meetings, conferences, and events in a positive and professional manner
- Must maintain confidentiality and project a professional business image
- Must be able to effectively lead and coach others
Desired Qualifications
- Knowledge of medical office workflows
- Knowledge of other Moda Health products, plans, and networks
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