Provider Network Specialist

Provider Network Specialist

We are seeking a Provider Network Specialist to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

The Provider Network Specialist plays an essential role in managing and optimizing the healthcare provider network to ensure high-quality, cost-effective care for members. This position involves building and maintaining strong relationships with healthcare providers, negotiating contracts, and ensuring compliance with regulatory requirements. The specialist will analyze network performance data to identify gaps and opportunities for improvement, contributing to the overall strategy for network development. Collaboration with internal teams such as claims, utilization management, and member services is essential to address provider issues and enhance network adequacy. Ultimately, this role ensures that members have access to a comprehensive and efficient provider network that meets their healthcare needs.

Minimum Qualifications:

• Bachelor's degree in healthcare administration, business, or a related field.
• Minimum of 2 years experience in provider network management or healthcare contracting.
• Strong knowledge of healthcare provider types, insurance products, and regulatory requirements.
• Proficiency with data analysis and network management software.
• Excellent communication and negotiation skills.
• Relevant experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications:

• Experience working within a managed care organization or health plan.
• Familiarity with provider credentialing processes and standards.
• Advanced skills in data analytics tools such as Excel, SQL, or business intelligence platforms.
• Certification in healthcare contracting or network management (e.g., CPHQ, CNE).
• Knowledge of federal and state healthcare regulations impacting provider networks.

Responsibilities:

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
• Builds and maintains positive, professional relationships with contracted and subcontracted providers by supporting provider engagement initiatives, serving as a trusted liaison, addressing provider concerns, and promoting provider satisfaction through responsive and collaborative service.
• Coordinates provider onboarding, orientation, and operational integration activities while ensuring providers understand organizational workflows, documentation standards, operational expectations, and service delivery requirements.
• Develops and delivers timely, accurate provider communications and educational resources related to organizational policies, operational changes, compliance requirements, workflow expectations, quality initiatives, and program updates.
• Responds to provider inquiries, complaints, and operational concerns in a timely, professional, and solution-oriented manner by coordinating appropriate follow-up activities, tracking resolutions, and promoting positive provider experiences.
• Maintains accurate provider records and operational tracking tools while compiling, validating, analyzing, and reporting provider performance data, operational metrics, provider trends, and engagement activities to support informed decision-making.
• Collaborates effectively with Operations, Clinical, Quality, Compliance, Credentialing, Care Management, Claims, Provider Network, and other cross-functional teams to support organizational objectives, provider success, and high-quality member care.
• Maintains organized documentation, monitors provider-related action items, escalations, and operational activities, and consistently demonstrates accountability by ensuring work is completed accurately, timely, and in accordance with organizational standards.
• Supports compliance with applicable federal, state, health plan, contractual, and organizational requirements by assisting with audits, delegated oversight activities, operational reviews, corrective action plans, and provider-related compliance initiatives.
• Performs other duties as required or assigned.