Provider Engagement Specialist

Job Summary

Acting as the primary liaison for provider networking, the full-time Senior Provider Engagement Network Specialist will manage provider setup in the information system, oversee network reporting and directories, and resolve claims payment issues while working remotely.

Key responsibilities

• Maintain positive relationships with participating providers and act as an account manager for assigned groups
• Oversee the administration of contractual provider relationships, ensuring accurate provider databases and providing necessary training and support
• Research and resolve complex provider-related issues, including contract loading and claims disputes

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 benefits interpretation
• Strong understanding of internal operations of provider relations