Egid Provider Relations Specialist

Job Posting Title

EGID Provider Relations Specialist

Agency

807 HEALTH CARE AUTHORITY

Supervisory Organization

EGID

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

$22.81875 / hourly

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. Learn more about OHCA.

Let's Talk Benefits

We know your great work deserves great support. Here's a snapshot of what we offer for all eligible employees.

• 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

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $22.81875 per hour

Work Schedule: Monday- Friday

Primary Hours: 8:00 a.m.- 5:00 p.m.

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Provider Relations Specialist is responsible for provider communications and directories, reimbursement, escalations, ensuring compliance with various 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.

Principal Activities May Include:

• 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, and recruitments.

• 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 and Competency Requirements

The Provider Relations Specialist 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. The position demands knowledge of healthcare reimbursement practices, claims processing, insurance regulations, and benefit plan administration. Proficiency in Microsoft Office, particularly Excel and SharePoint, and familiarity with health care terminology and compliance requirements are essential. Success in this role hinges on the ability to interpret complex regulations, manage detailed data sets, and support cross-functional initiatives. The three Korn Ferry competencies most relevant to this position are Ensures Accountability (for maintaining accurate and timely provider data and reports), Customer Focus (for effectively responding to provider needs), and Optimizes Work Processes (for streamlining communication and directory updates in compliance with regulatory requirements).

To be considered for this position your application must include a resume/CV with complete work and education history.

Education and/or 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 Include:

• Knowledge of Microsoft Office with a fundamental knowledge of Excel functions, Visual Basic for Applications (VBA) and working with large data sets in various applications.

• 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 settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of the job.

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.

Notice to applicants:

Please add OHCAHR@okhca.org to the address book or "safe-senders" list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub.

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.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

If you are needing any extra assistance or have any questions relating to a job you have applied for, please click the link below and find the agency for which you applied for additional information:

Agency Contact