Ohio Provider Engagement Specialist

Job Summary

Acting as a liaison for provider networking, the full-time Senior Provider Engagement Network Specialist will manage provider setup in the information system, oversee claims payment resolution, and maintain relationships with participating providers while working remotely from Ohio.

Key responsibilities

• Manage day-to-day operations of provider relationships, ensuring accurate provider data for reporting and claims
• Research and resolve complex provider-related issues, including contract interpretation and eligibility concerns
• Provide training and support to external provider representatives and serve as a subject matter expert in provider services

Required qualifications

• Bachelor's degree in a healthcare-related field or equivalent experience
• 5+ years of provider services experience in a managed healthcare environment
• Experience with provider contracting and servicing benefits interpretation
• Strong understanding of internal operations of provider relations