New Jersey Licensed Provider Specialist

Job Summary

To support provider relations in New Jersey, the full-time Senior Provider Engagement Network Specialist will manage provider setup in the information system, resolve claims payment issues, and maintain relationships with participating providers while working remotely.

Key responsibilities

• Act as the internal and external liaison for provider networking, ensuring positive relationships with physicians and groups
• Oversee daily administration of contractual provider relationships, including maintaining accurate provider databases and providing training
• Research and resolve complex issues related to contract loading, financial responsibility interpretation, and provider claims

Required qualifications

• Bachelor's degree in a healthcare-related field or equivalent experience required
• 5+ years of provider services experience, particularly in a managed healthcare environment
• Experience with provider contracting and benefits interpretation
• Strong understanding of internal operations of provider relations
• Authorization to work in the U.S. without the need for employment-based visa sponsorship