Job Title
EGID Provider Relations Specialist
Agency & Location Agency
807 Health Care Authority (OHCA)
Location
4345 N Lincoln Blvd, Oklahoma City, OK 73105
Compensation & Schedule Salary
$22.82 per hour
Work Schedule
Monday – Friday, 8:00 a.m. – 5:00 p.m.
Why You’ll Love Working Here At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values,
Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership , we foster a workplace where people feel supported, respected, and empowered to make an impact.
Benefits Snapshot
Generous state‑paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre‑existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
Retirement Savings Plan with employer contributions.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits, including an on‑site gym and fitness center discounts.
Job Description Position Purpose
– The Provider Relations Specialist is responsible for provider communications and directories, reimbursement, escalations, ensuring compliance with regulations and rules, and providing exceptional customer service through effective communication and problem‑solving skills. This role is essential in maintaining the accuracy and integrity of provider information and supporting the overall efficiency of the Network Management team.
Key Activities
Manage provider communications, update provider directories, and ensure accuracy and timeliness of information.
Conduct monthly provider directory audits, handle inactive provider terminations, and compile statutorily required reports.
Respond to provider emails and phone calls, maintain a high level of customer service.
Maintain SharePoint site, monitor unit reports, communicate and assist with reimbursement and fee schedules, and assist in the development and implementation of business reports and project plans.
Other duties as assigned.
Knowledge, Skills & Abilities The role requires strong analytical and communication skills to manage provider communications, maintain accurate directories, and respond to provider inquiries with a high level of customer service. Key knowledge areas include healthcare reimbursement practices, claims processing, insurance regulations, and benefit plan administration. Proficiency in Microsoft Office, especially Excel and SharePoint, and familiarity with healthcare terminology and compliance requirements are essential.
To be considered Include a resume/CV with complete work and education history.
Education and Experience
A bachelor’s degree and 2 years of experience in health insurance benefit administration or health care industry provider contracting.
OR an equivalent combination of education and experience.
Preference Qualifications
Knowledge of Microsoft Office, fundamental Excel functions, VBA, and working with large data sets.
Knowledge of state and federal laws and regulations pertaining to various types of health and dental benefit plans and federally mandated programs, including CMS‑Medicare guidelines.
Knowledge of medical and dental markets, insurance & contracting terminology, practices, and process controls.
Knowledge of Medicare and commercial reimbursement methodologies and related coding systems.
Knowledge of claims processing systems and guidelines.
Knowledge of and experience with the No Surprises Act.
Knowledge of insurance plan related administrative procedures.
Physical Demands and Work Environment Work is typically performed in an office setting with climate‑controlled conditions and moderate noise levels. The position requires speaking, standing, walking, reaching, and extensive use of computers and phones. Employees must be willing to complete all job‑related travel. Presence at the office is an essential function.
Accommodation Statement The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405‑522‑7335.
Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Application Notes Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
If you need extra assistance or have any questions regarding a job you have applied for, contact the agency for more information.
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Agency & Location Agency
807 Health Care Authority (OHCA)
Location
4345 N Lincoln Blvd, Oklahoma City, OK 73105
Compensation & Schedule Salary
$22.82 per hour
Work Schedule
Monday – Friday, 8:00 a.m. – 5:00 p.m.
Why You’ll Love Working Here At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values,
Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership , we foster a workplace where people feel supported, respected, and empowered to make an impact.
Benefits Snapshot
Generous state‑paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre‑existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
Retirement Savings Plan with employer contributions.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits, including an on‑site gym and fitness center discounts.
Job Description Position Purpose
– The Provider Relations Specialist is responsible for provider communications and directories, reimbursement, escalations, ensuring compliance with regulations and rules, and providing exceptional customer service through effective communication and problem‑solving skills. This role is essential in maintaining the accuracy and integrity of provider information and supporting the overall efficiency of the Network Management team.
Key Activities
Manage provider communications, update provider directories, and ensure accuracy and timeliness of information.
Conduct monthly provider directory audits, handle inactive provider terminations, and compile statutorily required reports.
Respond to provider emails and phone calls, maintain a high level of customer service.
Maintain SharePoint site, monitor unit reports, communicate and assist with reimbursement and fee schedules, and assist in the development and implementation of business reports and project plans.
Other duties as assigned.
Knowledge, Skills & Abilities The role requires strong analytical and communication skills to manage provider communications, maintain accurate directories, and respond to provider inquiries with a high level of customer service. Key knowledge areas include healthcare reimbursement practices, claims processing, insurance regulations, and benefit plan administration. Proficiency in Microsoft Office, especially Excel and SharePoint, and familiarity with healthcare terminology and compliance requirements are essential.
To be considered Include a resume/CV with complete work and education history.
Education and Experience
A bachelor’s degree and 2 years of experience in health insurance benefit administration or health care industry provider contracting.
OR an equivalent combination of education and experience.
Preference Qualifications
Knowledge of Microsoft Office, fundamental Excel functions, VBA, and working with large data sets.
Knowledge of state and federal laws and regulations pertaining to various types of health and dental benefit plans and federally mandated programs, including CMS‑Medicare guidelines.
Knowledge of medical and dental markets, insurance & contracting terminology, practices, and process controls.
Knowledge of Medicare and commercial reimbursement methodologies and related coding systems.
Knowledge of claims processing systems and guidelines.
Knowledge of and experience with the No Surprises Act.
Knowledge of insurance plan related administrative procedures.
Physical Demands and Work Environment Work is typically performed in an office setting with climate‑controlled conditions and moderate noise levels. The position requires speaking, standing, walking, reaching, and extensive use of computers and phones. Employees must be willing to complete all job‑related travel. Presence at the office is an essential function.
Accommodation Statement The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405‑522‑7335.
Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Application Notes Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
If you need extra assistance or have any questions regarding a job you have applied for, contact the agency for more information.
#J-18808-Ljbffr