Carolina Complete Health Network

Compensation

Full Description

Location: This is a primarily remote position, but you must be located in North Carolina. About CCHN: Carolina Complete Health Network was founded in 2016 and is North Carolina’s only Physician-Led Medicaid Plan (also known as a Provider Led Entity). It’s the result of a collaborative joint venture between the NC Medical Society, the NC Community Health Center Association, and Centene Corporation. We give medical care providers and Federally Qualified Health Centers (FQHC) a voice in policymaking which ultimately results in better patient outcomes, helping patients get the care they need when they need it through local, regional, and community based resources. 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 Carolina Complete Health Network is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.