Are you a planning, communication, and customer service expert? We are looking for a Provider Relations & Contracting Specialist I for our client in Fresno, CA. The ideal candidate has 2 years experience with provider claims, project managment with great communication skills. We are looking for a multi-tasker who thrives in a fast paced environment and enjoys helping others! Education/Experience: Bachelor’s Degree in healthcare administration, business administration or equivalent experience. 2+ years of provider relations or contracting experience in health care, managed care, Medicare or Medicaid service environment.
Serves as a liaison between providers, the health plan and Corporate. Responsible for investigating and resolving provider issues and conducting new provider orientations and educating providers on policies and procedures.
- Serve as contact for provider inquires and track inquiries and response times.
- Draft contracts and manage contracting process to verify that contract deadlines are met
- Monitor provider credentialing activities and contact providers for missing or incomplete information.
- Maintain and update provider databases to include key provider demographics and specialty provider information
- Conduct administrative audits of provider agencies to evaluate provider contract adherence
- Review, audit and price contract related pends to verify claims payment accuracy
- Record, track, and monitor provider contract deliverables
- Maintain the Provider Manual and update orientation materials as assigned.
- Must have the ability to travel
- Claims Processing
- Management Responsibility (2 years of experience is preferred)
- Excel (2 years of experience is required)
- Verbal Communication
- Vendor Relations
- Written Communication
- Years of experience: 2 years
- Experience level:Experienced
Working hours: 8 AM - 5 PM
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Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.