Provider Network Specialist-255100

Job Description

Job Description

Responsibilities:

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

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

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• Monday–Friday, 9:00 AM – 5:00 PM (35-hour work week).
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• During the first 4–5 months, the schedule will be hybrid:
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• Monday and Friday: Remote
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• Tuesday, Wednesday, and Thursday: In-office
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• 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.
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• Monday and Friday: Remote work and/or field-based provider visits
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• Tuesday, Wednesday, and Thursday: In-office
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