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 Contracting Specialist is responsible for managing provider contracts, maintaining provider relationships, and ensuring compliance with applicable regulations and policies. This role includes handling incoming and outgoing communications, maintaining accurate provider data, and supporting provider network management activities to ensure efficient and effective service delivery.  

Essential Functions May Include:  

• Ensure accurate and timely management of provider contracts, including pricing NSA claims, negotiating NSA requests, and responding to independent dispute resolutions.   

• Foster strong working relationships with providers through effective communication, timely response to inquiries, and proactive resolution of issues.   

• Adhere to HIPAA regulations, OMES policies, and other relevant statutes by protecting the privacy and confidentiality of program participants' information.   

• Enter and review provider demographics accurately and timely, ensuring an accuracy rate of 97% or better based on audits.   

• Handle incoming and outgoing calls, emails, and provider retention tasks while maintaining a customer service quality audit score of 85% or better.   

• Other duties as assigned.   

Knowledge, Skills,/ Abilities and Competency Requirements 

• 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 Medicare guidelines policies and procedures.   

• Knowledge of provider licensing, certification, contractual issues, reimbursement, procedural coding, benefit coverage and liability requirements. Knowledge regarding these laws, regulations and procedures are critical to the management of an effective Provider Network.   

• Knowledge of provider database maintenance, plan provisions, agency policies, provider types, credentials management, coding and reimbursement methods, claims payment process, and contract provisions/terminology.   

• Strong organizational skills.    

• Knowledge of large group network management and provider services to include provider enrollment and contracting, verbal and written communication skills, customer services and experience providing phone coverage, provider recruitment, training, response to member and provider inquiries, use of network database applications   

• Requires a detailed understanding of insurance plan provisions, terms, policies, provider types, credentials management, coding and reimbursement methods, claims payment processes, contract provisions and terminology.   

• Knowledge of and ability to use Microsoft Office Applications.   

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 this position.  

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 [email protected]  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.