Provider Network Specialist

Provider Network Specialist

The Provider Network Specialist plays a critical role in managing and executing Single Referral Agreements (SRAs) to ensure timely access to care for injured workers while supporting network growth and cost containment. This role is responsible for rapid provider outreach, negotiation, and placement execution on a case-by-case basis, with a strong emphasis on converting SRA providers into long-term, in-network partners. The Provider Network Specialist operates in a fast-paced environment, balancing high-volume referral management with strategic provider engagement. This position requires strong negotiation skills, persistence in outreach efforts, and the ability to drive results under tight timelines. Close collaboration with internal teams and external stakeholders is essential to ensure service level expectations are met and exceeded.

Essential Job Duties and Responsibilities

SRA Management & Placement Execution (Primary Focus)

• Own and manage assigned single referral (SRA) cases from SRA intake through SRA scheduling, ensuring adherence to SLAs and client expectations.
• Conduct rapid, multi-channel provider outreach (phone, fax, email) to secure agreement participation and confirm timely scheduling (target: within 48 hours).
• Act as a strong problem solver, proactively identifying and overcoming barriers to placement such as provider unresponsiveness, rate objections, and scheduling constraints.
• Develop creative, solution-oriented approaches to ensure successful placement while maintaining compliance with company standards.
• Provide timely, accurate updates to internal stakeholders (adjusters, nurse case managers, clients) on case status and risks (every 48 hours).

Provider Negotiation & Relationship Management

• Negotiate Single Rate Agreements (SRAs) in alignment with company reimbursement guidelines and operational standards.
• Effectively communicate the value of partnering with a third-party workers' compensation network to encourage participation.
• Identify high-utilization SRA providers and support conversion efforts to full network participation.
• Maintain professional and persistent follow-up to drive provider responsiveness and agreement execution.

Network Development & Support

• Conduct targeted research and outreach to identify providers for network inclusion, with emphasis on coverage gaps and high-demand markets.
• Support contracting efforts by gathering required documentation and ensuring compliance with onboarding requirements.
• Assist with SRA-to-contract conversion initiatives in collaboration with the contracting team.

Operational Excellence & Documentation

• Accurately document all activities, communications, and outcomes within Salesforce and internal systems.
• Maintain strong attention to detail across multiple systems to ensure data integrity and reporting accuracy.
• Manage a high-volume workload while prioritizing urgent cases and meeting established KPIs.

Cross-Functional Collaboration

• Partner with internal teams including Customer Solutions, Visit Management, and Provider Enrollment to ensure seamless case handling and provider onboarding.
• Deliver a high level of service to all stakeholders, including injured workers, providers, adjusters, and internal partners.

Minimum Qualifications (Knowledge, Skills, and Abilities)

• Bachelor's degree or equivalent combination of education and experience.
• Experience in workers' compensation, healthcare network operations, provider relations, or inside sales strongly preferred.
• Demonstrated ability to negotiate, influence, and drive outcomes in time-sensitive situations.
• Strong communication skills (verbal and written) with the ability to engage effectively with external partners.
• Experience with Salesforce or similar CRM systems preferred.
• Ability to manage multiple priorities in a fast-paced, high-volume environment.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodation may be provided to enable individuals with disabilities to perform the functions.

Prolonged periods sitting at a desk and working on a computer

Bardavon offers a complete benefits package, including medical, dental, and vision insurance; 401(k); and generous paid time off. EOE M/F/D/V