Provider Enrollment Field Representative

Job description

·  Job Description:

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Implements general provider contracting, insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate provider contract data. provides on-site visits with providers to resolve contracting problems/issues and to confirm contracting requirements. Advises provider on initial and renewal contract creation. Works directly with state Medicaid agency for additional duties as needed.

Responsibilities:

·  Participates in the identification, documentation, analysis and validation of basic business processes, systems, and solution requirements for provider contracts.
·  Review data and make independent decisions with some direction.
·  Learn policies and procedures as they relate to the contracting.
·  Researches components of solutions to problems.
·  Learn how to handle escalated issues from the customer and provider community.
·  Supports requirements of business unit and customer.
·  Learn internal processes tools.
·  Works effectively in a team environment.
·  Establishes customer satisfaction by responding to requests for in a timely and quality manner.
·  Ability to take direction and follow general instructions.
·  Manage assignments with limited supervision.
·  Manage requests from customers and leaders.

Education and Experience Required:

·  Bachelor's degree in insurance, healthcare or related field or High School Diploma or equivalent; may hold 2 year post-high school Degree (insurance, healthcare or related field) or 4-5 years direct experience with Oklahoma SoonerCare program.
·  Typically, 1-3 years of additional working experience.

Knowledge and Skills:

·  General healthcare knowledge of commercial and government insurance programs.
·  Basic understanding of healthcare related technologies.
·  Basic knowledge of project management, research and problem resolution techniques.
·  Ability to plan and meet deadlines.
·  Ability to communicate effectively with both internal and external customers.
·  Good written and verbal communication skills.
·  Ability to understand instructions and accomplish tasks.
·  Ability to work in a team environment.
·  Good business and technical writing skills to ensure that all documentation meets required standards.
·  Advanced computer skills to minimize training time for organization specific software.
·  Good research skills.