Provider Relations / Contracting Specialist I

  • location: Fresno, CA
  • type: Permanent
  • salary: $45,100 - $76,500 per year

job description

Provider Relations / Contracting Specialist I

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.  

Responsibilities

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


Skills
  • Claims Processing
  • Management Responsibility (2 years of experience is preferred)
  • Excel (2 years of experience is required)
  • Verbal Communication
  • Vendor Relations
  • Written Communication
Education
  • Bachelors (required)
Qualifications
  • Years of experience: 2 years
  • Experience level:Experienced
Shift: First

Working hours: 8 AM - 5 PM

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EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.

San Francisco Fair Chance Ordinance:

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.


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