Provider Network Specialist

Job Description

MUST BE LOCATED IN GEORGIA

A bit about the role....

This highly impactful role will analyze provider demographic information, financial data, quality reports, and special project data. A key responsibility is supporting the performance team in preparing for and executing monthly provider performance meetings, ensuring insights are actionable and aligned with performance goals. The ideal candidate brings a strong understanding of data analysis , claims payment processes, provider setup, and root cause analysis, with a clear focus on improving provider engagement. Success in this role requires the ability to work both independently and collaboratively, strong organizational discipline, and a results-driven mindset.


Key Responsibilities and Impact

Provider Performance Audits

• Conduct in-depth audits across provider performance systems, including Orinoco (demographics and fee schedules), online search tools, print directories, Looker reports, and claims payment processes. Evaluate data through a performance lens to identify gaps, inefficiencies, and root causes impacting provider performance. Deliver clear, actionable insights and partner with the performance team to implement improvements that enhance overall provider effectiveness.

Field Performance Support and Issue Resolution

• Support Field Performance initiatives by engaging directly with providers to resolve provider-related issues. Ensure timely resolution and clear documentation.

Provider Onboarding

• Manage the full contract lifecycle while maintaining a focus on onboarding high-performing providers and improving overall engagement.

Performance Reporting and Operational Support (JOC)

• Partner with Performance Managers to prepare for monthly performance meetings by pulling data by leveraging AI-driven prompts with a strong emphasis on advanced AI tools and preparing slide decks and follow up items from previous meetings.

Required Skills and Experience:

• A minimum of 3 years of healthcare experience, preferably in Medicare Advantage or similar environments
• 5 years of direct provider interaction experience
• Demonstrated ability to manage detailed, performance-driven work
• Proficiency in Google or MS Suite Workspace applications.
• Experience in claims research, provider setup, root cause analysis, and process improvement with a focus on provider engagement
• Strong written and oral communication skills

Desired Skills and Experience

• Organized and detail oriented
• Ability to effectively manage competing priorities and ambiguity is essential
• Ability to gather, read, analyze, and interpret complex data and create accurate meaningful information for data reporting
• Ability to facilitate meetings, and make presentations before groups of management and staff.

Additional Information

• Remote Role - must reside in (Georgia )
• Travel - 10% - 15% travel to offices may be required.

Salary range: $65,000 - $85,000 per year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.