Role Overview: The Provider Network Contract Representative oversees the daily operations related to Out of Network (OON) agreements, provider contracts, and Supplemental Medical Assistance Enrollment applications. This role ensures the timely and accurate processing of provider agreements and supplemental packets, maintains detailed records, and supports providers through complex enrollment and documentation processes. The Specialist liaises between providers and internal departments such as Credentialing, Clinical, Member Services, and Provider Maintenance, ensuring compliance with state regulations and internal standards. A strong understanding of Medicaid, Medicare, and state-funded programs is essential, along with the ability to multitask, communicate effectively, and resolve issues efficiently.

Work Arrangement:

• Hybrid—The Associate must be in the office at 8040 Carlson Road, Harrisburg, PA 17112, at least two (2) days per week on Tuesdays and Wednesdays.

Responsibilities:

• Ensure timely distribution and accurate documentation of provider contracts and supplemental packets.
• Submit provider agreements and enrollment information to Credentialing, Account Executive (AE), and Provider Maintenance departments.
• Maintain expert knowledge of Medical Assistance enrollment types and CPT code requirements by provider specialty.
• Assist providers in completing supplemental packets and OON documentation in compliance with state regulations.
• Monitor and manage EXP workflow for OON requests, ensuring turnaround times meet PerformCare standards.
• Act as a liaison between providers and the Office of Mental Health & Substance Abuse Services (OMHSAS), supporting Medicaid enrollment and documentation processes.
• Coordinate with internal departments to ensure accurate provider setup in systems and proper claims payment.
• Adhere to all organizational policies, including confidentiality, compliance, and fraud prevention protocols.

Education & Experience:

• High School Diploma or GED required
• An associate’s degree in business administration, communication, or a related field is preferred.
• Minimum of 2 years of experience in a Behavioral Health or Managed Care environment, with direct provider interaction.

Skills & Abilities:

• Experience in customer service, demonstrating strong communication and problem-solving skills.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Our Comprehensive Benefits Package - Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k), Tuition reimbursement, and more.