Network Relations Manager

Jobtailor; Tulsa (OK); On-site; USD 75,000 - 120,000; Full time

Job summary

Jobtailor is seeking an experienced healthcare professional to manage Medicaid provider relationships in Oklahoma. The role focuses on contract interpretation, credentialing, and provider education while addressing complex policy questions and claims issues.

You will drive service level improvements, cross-functional collaboration, and provider communications to support large system implementations and cost initiatives.

Qualifications

• Minimum 5 years' work experience in healthcare.
• Minimum 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.
• Ability to travel within the defined territory 50–80% of the time.
• Must reside in Oklahoma.
• Knowledge of Medicaid regulatory standards for network access, credentialing, claim lifecycle, provider appeals and disputes, and network performance standards.
• Experience with medical terminology, CPT, ICD-10 codes, etc.
• Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills.

Responsibilities

• Act as the primary resource for assigned high-profile Medicaid providers and groups
• Establish, oversee, and maintain positive 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 initiatives, trend identification, and problem resolution
• Provide guidance and training to less experienced team members
• Collaborate with Provider Enablement & Strategy on provider-facing communications, workflows, external trainings, reporting needs, and HUB support
• Perform other duties as assigned

Skills

Provider Education

Contract Coordination

Database Management

CPT Codes

ICD-10 Codes

Claims Processing

Problem Resolution

Trend Identification

Verbal Communication

Written Communication

Interpersonal Skills

Critical Thinking

Job description

• Act as the primary resource for assigned high-profile Medicaid providers and groups
• Establish, oversee, and maintain positive 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 initiatives, trend identification, and problem resolution
• Provide guidance and training to less experienced team members
• Collaborate with Provider Enablement & Strategy on provider-facing communications, workflows, external trainings, reporting needs, and HUB support
• Perform other duties as assigned

Requirements

• Minimum 5 years' work experience in healthcare
• Minimum 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
• Ability to travel within the defined territory 50–80% of the time
• Must reside in Oklahoma
• Knowledge of Medicaid regulatory standards for network access, credentialing, claim lifecycle, provider appeals and disputes, and network performance standards
• Experience with medical terminology, CPT, ICD-10 codes, etc.
• Strong verbal and written communication, interpersonal, problem resolution, and critical thinking skills

Core Competencies

Demonstrates extensive experience in Medicaid Managed Care, provider relationship management, and contract interpretation, with a strong focus on compliance with Medicaid regulatory standards and effective communication skills.

Highest-signal resume keywords

• Medicaid Managed Care Experience
• Provider Relationship Management
• Contract Interpretation
• Knowledge of Medicaid Regulatory Standards
• Medical Terminology Proficiency

ATS Optimization Keywords

Hard Skills

• Database Management
• Contract Coordination
• Credentialing Activities
• CPT Codes
• ICD-10 Codes
• Claims Processing
• Service Level Monitoring
• Provider Education
• Problem Resolution
• Trend Identification

Soft Skills

• Verbal Communication
• Written Communication
• Interpersonal Skills
• Critical Thinking
• Problem Resolution

Industry Keywords

• Healthcare
• Medicaid
• Provider Appeals
• Network Access
• Claim Lifecycle
• Network Performance Standards
• Provider Enablement
• External Training
• Workflows
• Reporting Needs