Job Description:
• Act as the primary resource for assigned, high-profile Behavioral Health providers and/or groups
• Establish, oversee, and maintain positive provider relationships
• Respond to complex issues related to Medicaid policies and procedures, plan design, contract language, service, claims, compensation, and provider education
• Optimize interactions with assigned providers and internal business partners
• Monitor service capabilities and collaborate cross-functionally to resolve escalated claims, contract, and provider information issues
• Support operational activities including database management and contract coordination
• Perform credentialing support activities as needed
• Educate Medicaid providers on contract policies, plan design, compensation processes, technology, policies, and procedures
• Meet with key providers regularly 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-facing communications, desktops, workflows, external training, reporting needs, and HUB support
• Perform other duties as assigned
Requirements:
• Minimum of 5 years' work experience in healthcare
• Minimum of 3 years' experience in a Medicaid Managed Care business segment environment servicing providers, with exposure to benefits and/or contract interpretation
• Minimum of 2 years’ experience working with providers and contracts in the behavioral health sector
• Working knowledge of business segment specific codes, products, and terminology
• Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint
• Travel within the defined territory up to 50-80% of the time
• Candidates must reside in the state of Louisiana and within one of the following parishes: St. Landry, Evangeline, Acadia, Lafayette, St. Martin, Iberia, Vermillion, Beauregard, Allen, Calcasieu, Jefferson Davis, Cameron, Avoyelles, Rapides, Vernon, Grant, Winn, LaSalle, Catahoula, Concordia
• 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.
Benefits:
• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being