Senior Provider Engagement Specialist

Job Summary

To support provider relations, the full-time Senior Provider Engagement Specialist will manage provider setup in the information system, ensure compliance with state deliverables, and resolve claims payment issues while working remotely with occasional travel for meetings.

Key responsibilities

• Act as the internal and external liaison for provider networking, maintaining relationships with participating physicians and groups
• Oversee the administration of contractual provider relationships, ensuring accurate provider databases and providing necessary training
• 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
• Knowledge of internal operations related to provider relations
• Must reside in Western/Southwestern Pennsylvania