Manager, Network Relations

Serve as the primary resource for assigned high-profile Medicaid providers and groups

Establish, oversee, and maintain provider relationships

Respond to complex issues involving Medicaid policies and procedures, plan design, contract language, service, claims, and compensation

Monitor service capabilities and collaborate cross-functionally to resolve escalated claims, contract, and provider information issues

Support database management, contract coordination, and credentialing activities

Educate Medicaid providers on contract policies, plan design, compensation processes, technology, policies, and procedures

Meet regularly with key providers to ensure service levels meet expectations

Develop agendas, validate materials, and facilitate external provider meetings

Collaborate on implementation of large provider systems, cost drivers, cost initiatives, trend identification, and problem resolution

Provide guidance and training to less experienced team members

Collaborate with Provider Enablement & Strategy on provider communications, workflows, trainings, reporting, and HUB support

Perform other duties as assigned

Requirements

Minimum of 5 years' work experience in healthcare

Minimum of 3 years' experience in a Medicaid Managed Care business segment environment servicing providers

Exposure to benefits and/or contract interpretation

Working knowledge of business segment specific codes, products, and terminology

Travel within the defined territory up to 50-80% of the time

Must reside in Dallas/Fort Worth Metroplex

Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards

Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Bachelor's degree preferred or a combination of professional work experience and education

Core Competencies

Demonstrates expertise in Medicaid Managed Care, provider relationship management, and contract interpretation, with a strong focus on compliance with Medicaid Regulatory Standards. Capable of educating providers on policies and procedures while facilitating effective communication and collaboration across teams.

Highest-signal resume keywords

Medicaid Managed Care Experience

Provider Relationship Management

Contract Interpretation

Knowledge of Medicaid Regulatory Standards

Medical Terminology Proficiency

Hard Skills

Contract Coordination

Credentialing Activities

Database Management

CPT Codes

ICD-10 Codes

Claims Processing

Provider Appeals

Network Performance Standards

Service Level Monitoring

Cost Initiative Implementation

Soft Skills

Cross-Functional Collaboration

Training and Guidance

Problem Resolution

Communication Skills

Meeting Facilitation

Industry Keywords

Healthcare

Medicaid

Provider Networks

Claims Lifecycle

Service Expectations

Provider Communications

Workflows

Trend Identification

Cost Drivers

Dallas/Fort Worth Metroplex

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