Provider Relations Specialist

Job Description:

Position Purpose: The Provider Relations Specialist plays a vital role in strengthening the relationship between Carolina Complete Health Network (CCHN), its provider partners, and affiliated health plans. Reporting to the Provider Relations Supervisor this position serves as a key operational liaison for Medicaid and Marketplace healthcare providers, helping to ensure smooth coordination across Carolina Complete Health (CCH), Ambetter, Centene, and CCHN. With a focus on provider support, education, and contract management, the Provider Relations Specialist contributes to the delivery of high-quality, equitable care across the network.

Key Responsibilities 

• Serve as the primary contact for Medicaid and Marketplace Healthcare Providers regarding operational and administrative questions and/or issues. 

• This role is similar to a call center environment, fielding inquiries from our provider network via phone, assisting with issues through to resolution or triaging calls to internal teams as needed.  

• Serve as a liaison between the Provider, the PHP and other key stakeholders. 

• Investigate, resolve and communicate Provider questions, issues and/or changes. 

• Educate Providers on CCH processes and operations. 

• Coordinate and negotiate contracts. 

• Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. 

• Assist in developing and maintaining the healthcare provider network plan for the awarded regions. 

• Assist in updating and maintaining the Provider CRM and contract database. 

• Partner with the health plan contract team to ensure State compliance. 

• Follow State mandated guidelines in relation to Provider Relations, Contracting and Medicaid Transformation. 

• Must be available to work Monday through Friday between the hours of 8:00am - 5:00pm 

• Protect confidential and sensitive business information, complying with Centene in NC firewall system, HIPAA, and CCHN partners 

• Perform other duties as delegated 

• Travel as needed (up to 10%) 

Skills and Qualifications 

• Bachelor's degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalent experience. 

• Excellent communication skills, enthusiasm, and the ability to engage with an audience. 

• Ability to handle multiple tasks at a time in a fast-paced environment. 

• Strong critical thinking capabilities, with the ability to prioritize tasks, think outside the box to solve problems, and continuous pursuit of resolution to best support our providers and team.  

• Demonstrated ownership mindset with a focus on delivering exemplary customer service, treating stakeholders with empathy and care while driving toward solutions.  

• Knowledge of healthcare, managed care, Marketplace, Medicare or Medicaid insurance is a plus. 

• Willingness to dig in and problem solve, then put a plan into action. 

• Current state drivers license 

• Reliable transportation as needed (to attend occasional in-person events).  

• Reliable, high-speed internet and the ability to work effectively independently in a remote/home office environment.  

CCHN Benefits

We offer a comprehensive benefits plan to help you care for you and your family's wellbeing:

• Medical, Dental, and Vision insurance plan offerings with a portion of premiums covered by CCHN (HSA and FSA eligible plans available!)

• Short/Long Term Disability and Supplemental Life Insurance included, as well as add-on options

• Annual wellness reimbursement

• 401k with company match

• Paid parental leave

• Paid time off