Oklahoma State Government
Network Management Fee Schedule Specialist
Oklahoma State Government, Oklahoma City, Oklahoma, United States, 73116
Job Posting Title
Network Management Fee Schedule Specialist
Agency: 807 HEALTH CARE AUTHORITY
Supervisory Organization: EGID
Job Type: Regular
Time: Full time
Compensation: $31.25 hourly
Job Description
Agency / Division Information The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, servant leadership. As part of the interview process candidates may be required to attend an in‑person interview at our Oklahoma City office.
Position Purpose The Fee Schedule Specialist is responsible for maintaining, analyzing, and updating provider fee schedules to facilitate accurate claim pricing and reimbursement. This role requires a strong understanding of medical coding reimbursement methodologies and regulatory guidelines, and works closely with provider relations, claims compliance, and finance teams to support operational accuracy and efficiency.
Principle Activities May Include
Maintain and update provider fee schedules within internal systems to facilitate accurate claim adjudication.
Analyze fee schedules for accuracy, consistency, and compliance with state, federal, and contractual requirements.
Research, interpret, and apply coding updates to reimbursement schedules.
Collaborate with internal teams to resolve claim pricing issues and discrepancies.
Monitor regulatory and industry changes affecting reimbursement methodologies and implement necessary updates.
Assist with provider contract implementation by ensuring accurate fee schedule configuration.
Support audits, compliance reviews, and reporting related to reimbursement.
Communicate clearly with providers and internal stakeholders regarding reimbursement policies and methodologies.
Other duties as assigned.
Supervisory Responsibilities This position does not supervise.
Knowledge, Skills, Abilities and Competencies This position requires in‑depth knowledge of insurance fee schedules and related state and federal legislation. Strong communication and collaboration skills are essential. The role also demands meticulous attention to detail while managing multiple priorities, and the ability to problem‑solve both analytically and strategically.
Education and / or Experience
High School Diploma or GED AND
2 years of professional experience in medical coding claims processing or provider reimbursement.
An equivalent combination of education and experience substituting one year of professional or technical administrative experience in business or public administration for each year of the required education.
No substitution allowed for the required professional experience in a supervisory or administrative capacity.
Preference may be given to candidates with
Certified Professional Coder (CPC) (or equivalent medical coding experience)
Proficiency with Microsoft Excel
Experience with claims processing systems
Physical Demands
Must be able to remain sitting for prolonged periods at a desk and working on a computer.
Must be able to move or lift up to 15 pounds at various times.
Work Environment The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines.
Why Youll Love Working Here At the Oklahoma Health Care Authority (OHCA) we’re proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years, this achievement reflects the dedication and collaborative spirit of our incredible team. Here’s what we offer to support employees and their families:
Generous state‑paid benefit allowance to offset insurance premiums.
Wide selection of top‑tier health insurance plans.
Optional flexible spending accounts for health care or dependent care expenses.
Employee Assistance Program (EAP) offering confidential support.
Wellness benefits, including an on‑site gym and fitness center discounts.
11 paid holidays annually.
15 vacation days and 15 sick days in your first year.
Retirement Savings Plan with substantial employer contributions.
Longevity Bonus to reward years of service.
Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.
Professional development training opportunities, including CEU support.
Accommodation Statement The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .
Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
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Agency: 807 HEALTH CARE AUTHORITY
Supervisory Organization: EGID
Job Type: Regular
Time: Full time
Compensation: $31.25 hourly
Job Description
Agency / Division Information The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, servant leadership. As part of the interview process candidates may be required to attend an in‑person interview at our Oklahoma City office.
Position Purpose The Fee Schedule Specialist is responsible for maintaining, analyzing, and updating provider fee schedules to facilitate accurate claim pricing and reimbursement. This role requires a strong understanding of medical coding reimbursement methodologies and regulatory guidelines, and works closely with provider relations, claims compliance, and finance teams to support operational accuracy and efficiency.
Principle Activities May Include
Maintain and update provider fee schedules within internal systems to facilitate accurate claim adjudication.
Analyze fee schedules for accuracy, consistency, and compliance with state, federal, and contractual requirements.
Research, interpret, and apply coding updates to reimbursement schedules.
Collaborate with internal teams to resolve claim pricing issues and discrepancies.
Monitor regulatory and industry changes affecting reimbursement methodologies and implement necessary updates.
Assist with provider contract implementation by ensuring accurate fee schedule configuration.
Support audits, compliance reviews, and reporting related to reimbursement.
Communicate clearly with providers and internal stakeholders regarding reimbursement policies and methodologies.
Other duties as assigned.
Supervisory Responsibilities This position does not supervise.
Knowledge, Skills, Abilities and Competencies This position requires in‑depth knowledge of insurance fee schedules and related state and federal legislation. Strong communication and collaboration skills are essential. The role also demands meticulous attention to detail while managing multiple priorities, and the ability to problem‑solve both analytically and strategically.
Education and / or Experience
High School Diploma or GED AND
2 years of professional experience in medical coding claims processing or provider reimbursement.
An equivalent combination of education and experience substituting one year of professional or technical administrative experience in business or public administration for each year of the required education.
No substitution allowed for the required professional experience in a supervisory or administrative capacity.
Preference may be given to candidates with
Certified Professional Coder (CPC) (or equivalent medical coding experience)
Proficiency with Microsoft Excel
Experience with claims processing systems
Physical Demands
Must be able to remain sitting for prolonged periods at a desk and working on a computer.
Must be able to move or lift up to 15 pounds at various times.
Work Environment The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines.
Why Youll Love Working Here At the Oklahoma Health Care Authority (OHCA) we’re proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years, this achievement reflects the dedication and collaborative spirit of our incredible team. Here’s what we offer to support employees and their families:
Generous state‑paid benefit allowance to offset insurance premiums.
Wide selection of top‑tier health insurance plans.
Optional flexible spending accounts for health care or dependent care expenses.
Employee Assistance Program (EAP) offering confidential support.
Wellness benefits, including an on‑site gym and fitness center discounts.
11 paid holidays annually.
15 vacation days and 15 sick days in your first year.
Retirement Savings Plan with substantial employer contributions.
Longevity Bonus to reward years of service.
Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.
Professional development training opportunities, including CEU support.
Accommodation Statement The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .
Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
#J-18808-Ljbffr