Medicaid Provider Network Relations Lead

Jobtailor; Fort Worth (TX); On-site; USD 95,000 - 135,000; Full time

Job summary

Jobtailor is seeking an experienced Medicaid Provider Relations professional to manage and nurture key provider relationships in a high-profile environment. You will resolve complex policy and contract questions, coordinate credentialing, and support claims and service inquiries across internal teams.

Travel up to 50-80% within the Texas territory is expected, with Dallas/Fort Worth residency required. The role emphasizes education of providers on policies, plan design, and compensation

Qualifications

• Minimum of 5 years' work experience in healthcare
• Minimum of 3 years' experience in a Medicaid Managed Care 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

Responsibilities

• 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

Skills

Cross-Functional Collaboration

Training and Guidance

Problem Resolution

Communication Skills

Meeting Facilitation

Education

Bachelor's degree preferred or combination of education and experience

Tools

Contract Coordination

Credentialing Activities

Database Management

CPT Codes

ICD-10 Codes

Claims Processing

Provider Appeals

Network Performance Standards

Service Level Monitoring

Cost Initiative Implementation

Job description

Jobtailor is seeking an experienced Medicaid Provider Relations professional to manage and nurture key provider relationships in a high-profile environment. You will resolve complex policy and contract questions, coordinate credentialing, and support claims and service inquiries across internal teams.

Travel up to 50-80% within the Texas territory is expected, with Dallas/Fort Worth residency required. The role emphasizes education of providers on policies, plan design, and compensation