Provider Network Specialist

SUMMARY

The Provider Network Specialist provides operational support for provider network management and credentialing functions. This position serves as a resource for provider onboarding, credentialing coordination, provider data maintenance, provider communications, reporting support, and provider network administration activities. The Provider Network Specialist works collaboratively with internal departments, providers, medical groups and administrative staff to ensure accurate provider information, timely credentialing and recredentialing activities, compliance with organizational requirements, and a positive provider experience by performing the following duties.

• Supports provider onboarding, credentialing, and recredentialing activities to ensure providers meet participation requirements and maintain compliance.


• Maintains accurate provider demographic and directory information to support regulatory compliance and member access to care.


• Assists with provider relations activities, including provider outreach, education, communications, issue resolution, and onboarding support.


• Supports provider network monitoring activities, including access and availability reviews, ADA accommodation tracking, secret shopper reviews, and provider data validation.


• Coordinates administrative activities for provider network management and credentialing, including report preparation, Provider Network Management Committee support, document management, and project tracking.


• Serves as administrative support contact for provider and clinic inquiries related to network participation, directory information and provider relations.


• Assists with provider onboarding activities, including collection and tracking of required documentation.


• Conducts routine provider outreach to verify provider information, office hours, capacity, ADA accommodations, and other network data.


• Assists with provider recruitment activities by coordinating outreach efforts, tracking opportunities, and maintaining recruitment records.


• Supports provider education initiatives through preparation and distribution of provider communications, training materials and updates.


• Maintains provider contract warehouse and other related documentation.


• Assists with preparation of provider network adequacy, access, and availability metrics to assist with monitoring procedures.


• Provides administrative support for the credentialing and recredentialing process.


• Conducts outreach to providers, clinics, and office staff regarding missing or incomplete credentialing documentation when necessary.


• Performs data entry and updates provider information within credentialing and provider management systems.


• Responds to routine credentialing inquiries.


• Maintains confidentiality and complies with HIPAA rules and regulations.


• Maintains punctual, regular, and predictable attendance.


• Works collaboratively in a team environment with a spirit of cooperation.


• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers, including the ability to communicate effectively and remain calm and courteous under pressure.


• Respectfully takes direction from manager.

EDUCATION and/or EXPERIENCE

Associate's degree or equivalent from two-year college or university; and two to three years related experience and/or training; or equivalent combination of education and experience.

COMPUTER SKILLS

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

Background Check & Drug Screen Required