Medicaid Provider Network Relations Lead

4004 Aetna Medicaid Administrators; Dallas (TX); On-site; USD 60,000 - 133,000; Full time

Job summary

4004 Aetna Medicaid Administrators is seeking a provider relations specialist to manage high-profile provider relationships and resolve complex Medicaid policy and contract questions. You will support credentialing, education, and cross-functional collaboration to ensure service levels meet defined expectations.

The role requires extensive travel (50–80%), a healthcare background, and experience with Medicaid Managed Care.

Qualifications

• Minimum of 5 years' work experience in healthcare.
• Minimum of 3 years' experience in Medicaid Managed Care with provider interactions.
• Willing to travel within the defined territory up to 50-80% of the time; must reside in Dallas–Fort Worth Metroplex.

Responsibilities

• Serve as the primary resource for assigned providers to address complex issues regarding Medicaid policies, plan design, contracts, service, claims or compensation.
• Educate Medicaid providers to ensure compliance with contract policies and parameters, and provider education needs.
• Collaborate cross-functionally with internal teams to resolve escalated issues and support cost initiatives.
• Provide credentialing support activities as needed and participate in provider meetings.

Skills

Medicaid knowledge

Healthcare industry experience

Regulatory standards

Education

Bachelor's degree

Job description

4004 Aetna Medicaid Administrators is seeking a provider relations specialist to manage high-profile provider relationships and resolve complex Medicaid policy and contract questions. You will support credentialing, education, and cross-functional collaboration to ensure service levels meet defined expectations.

The role requires extensive travel (50–80%), a healthcare background, and experience with Medicaid Managed Care.