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Provider Contracting Specialist

Recruitment #180619-UNCA-16

Introduction

A resume and cover letter must be submitted along with your application.

The Office of Management and Enterprise Services (OMES) is a trusted, credible partner that empowers employees to provide valued business expertise allowing customers to focus on their missions across state government. OMES provides financial, property, purchasing, human resources and information technology services to all state agencies, and assists the Governor’s Office on budgetary policy matters.

Our mission is supporting our partners through unified business services.  The OMES mission requires a highly-qualified workforce committed to making government run in the most efficient, innovative manner possible. Achieving that mission takes team-oriented, solutions-driven professionals who understand the importance of partnering to achieve success.

The Employees Group Insurance Division (EGID) of OMES is seeking a full time Provider Contracting Specialist. This is a full time unclassified position in state government.  OMES offers a comprehensive Benefits Packet, including a generous benefit allowance to offset the cost of insurance premiums for employees and their eligible dependents.  For more information about the benefit allowance [click here].The annual salary for this position is up to $39,600.00 based on education and experience.

Position Summary
Position responsibilities are related to network management and provider services for HealthChoice (HC), Department of Rehabilitation Services (DRS) and Department of Corrections (DOC).  Duties and responsibilities include provider enrollment and contracting, verbal and written communication with providers including providing phone coverage for HC, DRS and DOC provider call loops, recruitment, provider training, response to department inquiries, management of network database application, and interaction with agency, Third Party Administrators (TPA) and provider staff.  This position requires a general understanding of provider database maintenance, plan provisions, agency policies, provider types, credentials management, coding and reimbursement methods, claims payment process, and contract provisions/terminology.

Position Responsibilities/Essential Functions
• Review and enter provider contracting information into Network Management database for HC, DOC and DRS networks according to procedures established including accuracy and minimum daily update requirements and provide all associated daily reporting.
• Provide phone coverage to HC, DOC and DRS network phone loops and document all incoming in NM database contact log.
• Review and respond to telephone and other correspondence inquiries regarding contracting and claims issues from providers, interagency and third party administrator and document all incoming and outgoing contacts in NM database contact log.
• Review and distribute appropriately departmental mail, faxes and email according to procedures established as assigned and provide all associated daily reporting.
• Recruiting for health and dental providers for HC, DOC and DRS as assigned.
• Assist with creation of provider education material, newsletters and articles for publication as assigned.
• Work with other agency and TPA staff to obtain goals and objective of agency including training, grievances, plan benefit changes, system updates and testing as assigned.
• Represent the agency in provider seminars, conferences and meetings as assigned.
• Performs special projects as requested by the supervisor or Network Management Director.
• Must comply with all agency, state and federal HIPAA and Fraud, Waste and Abuse policies and successfully complete annual trainings for compliance.

Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.

Education and Experience
Bachelor’s degree in a health care related field or three years in provider contracting related work.  Or an equivalent combination of education and experience.

Valued Skills and Experience
• Knowledge of Medicare guidelines policies and procedures.
• Knowledge of provider licensing, certification, contractual issues, reimbursement, procedural coding, benefit coverage and liability requirements. Knowledge regarding these laws, regulations and procedures are critical to the management of an effective Provider Network.
• Knowledge of provider database maintenance, plan provisions, agency policies, provider types, credentials management, coding and reimbursement methods, claims payment process, and contract provisions/terminology.
• Strong organizational skills.
• Knowledge of large group network management and provider services to include provider enrollment and contracting, verbal and written communication skills, customer services and experience providing phone coverage, provider recruitment, training, response to  member and provider inquiries, use of  network database applications
• Requires a detailed understanding of insurance plan provisions, terms, policies, provider types, credentials management, coding and reimbursement methods, claims payment processes, contract provisions and terminology.
• Knowledge of and ability to use Microsoft Office Applications.
• Ability to communicate effectively, both orally and in writing.
• Ability to establish and maintain effective working relationships with others.

Physical Demands and Work Environment
This position works in a comfortable office setting with a large percentage of the work day done on a computer and telephone.  The noise level is usually mild.  Ability to occasionally lift paper and office supplies and to perform job duties on a computer and telephone for 6-8 hours per day is necessary.  Occasional travel may be required.

 

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.

Conclusion

Veteran’s preference points apply only for initial appointment in the classified service.



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