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Position Summary: Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.
- Optimizes interactions with assigned providers and
internal business partners to establish and maintain
productive, professional relationships
- Monitors service capabilities and collaborates cross-
functionally to ensure that the needs of constituents are
met and that escalated issues related but not limited to,
claims payment, contract interpretation or parameters,
and accuracy of provider contract or demographic
information are resolved
- Supports or assists with operational activities that may
include, but are not limited to, database management,
and contract coordination
- Performs credentialing support activities as needed
- Educates Medicaid providers as needed to ensure
compliance with contract policies and parameters, plan
design, compensation process, technology, policies, and
procedures
- Meets with key providers regular intervals to ensure
service levels are meeting expectations
- Manages the development of agenda, validates
materials, and facilitates external provider meetings
- Collaborate cross-functionally on the
implementation of large provider systems, to manage
cost drivers and execute specific cost initiatives to
support business objectives and to identify trends and
enlist assistance in problem resolution
- Assist with standard provider recruitment, contracting, or
re- contracting activities and assist with more complex
contracting and discussions as needed by business
segment
- May provide guidance and training to less experienced
team members