Provider Relations Specialist - CCHN

Provider Relations Specialist

Location: Raleigh-Durham, Wilmington or Charlotte, NC / Homebased position

Position Purpose: Reporting to the Director, Provider Experience, the Provider Relations Specialist is a member of the Provider Relations 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.
• Educate 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 8:00am - 5:00pm
• Protect confidential and sensitive business information, complying with Centene in NC firewall system, HIPPA, and CCHN partners
• Perform other duties as delegated
• Travel as needed

Preferred Skills and Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience.
• Excellent communication skills, enthusiasm, and the ability to engage with an audience.
• Ability to handle multiple tasks at a time in a fast-paced environment.
• Knowledge of healthcare, managed care, Marketplace, Medicare or Medicaid insurance is a plus.
• Solid communication skills with the ability to show compassion.
• Willingness to dig in and problem solve, then put a plan into action.
• Current state drivers license

Carolina Complete Health Network is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.