Provider Relations Representative, Behavioral Health (Kentucky)

This is an individual contributor role. Position Summary Acts as the primary resource for assigned, high profile providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates Medicaid providers to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers at regular intervals to ensure service levels meet expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Collaborates cross-functionally with the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and identify trends and enlist assistance in problem resolution. May provide guidance and training to less experienced team members. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills. Collaborates with Provider Enablement & Strategy on provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support. Other duties as assigned. Required Qualifications A minimum of 5 years' work experience in healthcare. Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation. Working knowledge of business segment specific codes, products, and terminology. Travel within the defined territory up to 50‑80% of the time. Must reside in KY (within 3 hours of the capital). Preferred Qualifications 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. Education Bachelor's degree preferred or a combination of professional work experience and education. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is $54,300.00 to $119,340.00, representing the base hourly rate or base annual full-time salary. The final base salary will depend on experience, education, geography and other factors. This position is eligible for a bonus, commission or short‑term incentive program in addition to the base pay range. Great benefits for great people This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Capacity Path