Provider Network Specialist-255100

Job Description

Responsibilities:

• Actively communicate with prospective and contracted providers based on business needs.
• Guide prospective providers through the application, credentialing, contracting, and onboarding processes.
• Conduct prospective provider site visits, as applicable.
• Facilitate new provider orientations and ongoing provider education and training.
• Foster and maintain positive provider network relationships.
• Develop and strengthen relationships with providers, office staff, and key stakeholders.
• Maintain accurate provider contact information, including key contacts within credentialing, claims, contracting, quality, population health, and provider operations.
• Manage an assigned provider territory, including strategic network partnerships and provider engagement initiatives.
• Serve as a primary point of contact for providers, offering support regarding network participation, provider resources, directory accuracy, operational processes, claims inquiries, and reimbursement questions.
• Schedule and conduct provider office and facility visits in accordance with departmental goals and outreach initiatives.
• Investigate, resolve, and respond to provider inquiries related to participation requirements, credentialing status, contract terms, reimbursement, claims, utilization, access and availability standards, member eligibility, and provider data management.
• Document, track, and monitor provider issues through resolution in accordance with organizational policies and procedures.
• Collaborate across departments to resolve complex provider concerns and identify trends impacting provider satisfaction and network performance.
• Partner with business development, marketing, and community outreach teams to support network growth and provider engagement efforts.
• Prepare and analyze reports related to network adequacy, provider access, and network performance.
• Monitor provider contract performance and network effectiveness through site visits, claims data, and performance analytics.
• Support quality improvement initiatives and ensure compliance with applicable regulatory and organizational standards.
• Collaborate with Quality and Population Health teams to promote quality measures, improve provider performance, and enhance patient outcomes.
• Perform additional duties and special projects as assigned.

Required Skills:

• Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, Access, and Salesforce.
• Strong organizational skills with exceptional attention to detail.
• Effective presentation and public speaking skills.
• Accurate and efficient data entry and record management abilities.
• Ability to manage multiple priorities, adapt to changing business needs, and meet strict deadlines.
• Strong verbal and written communication skills, with excellent analytical and problem-solving abilities.
• Knowledge of healthcare, medical, and managed care terminology.
• Must have a car and valid driver’s license.

Schedule:

• Monday–Friday, 9:00 AM – 5:00 PM (35-hour work week).
• During the first 4–5 months, the schedule will be hybrid:
• Monday and Friday: Remote
• Tuesday, Wednesday, and Thursday: In-office
• Following the onboarding and training period (approximately 4–5 months), the hybrid schedule will remain in place; however, the role will also include in-person provider visits and meetings.
• Monday and Friday: Remote work and/or field-based provider visits
• Tuesday, Wednesday, and Thursday: In-office