Provider Management Specialist

Staffing Solutions Organization LLC (SSO)

2d•$51,000 - $53,000•Remote

About The Position

The Provider Management Specialist I is responsible for supporting provider compliance, monitoring, and quality assurance activities. This position works directly with healthcare and community-based providers to assess compliance with applicable regulations, review documentation and business practices, conduct provider interviews, and identify opportunities for operational improvement. The successful candidate will possess strong analytical, communication, and customer service skills, along with the ability to work independently while maintaining positive provider relationships.

Requirements

Strong verbal and written communication skills.
Excellent customer service and relationship-building abilities.
Active listening and interviewing skills.
Strong attention to detail and accuracy.
Ability to analyze information and make sound recommendations.
Strong organizational and time-management skills.
Ability to work independently and collaboratively within a team environment.
Ability to prioritize multiple tasks and meet deadlines.
Process-oriented and results-driven approach to work.
Microsoft Word
Microsoft Excel
Microsoft Outlook
Internet and web-based applications
Electronic documentation systems

Nice To Haves

Bachelor's degree in any field preferred.
Two (2) or more years of experience working with: Critical care providers, Public health providers, Providers serving children, Providers serving older adults, Providers serving individuals with traumatic brain injuries, Providers serving individuals with developmental disabilities.
One (1) or more years of experience in: Provider monitoring, Provider compliance, Medicaid programs, Third-party payer billing, Provider education and training.

Responsibilities

Build and maintain positive relationships with providers and stakeholders.
Serve as a professional point of contact for provider inquiries.
Deliver a high level of customer service through effective communication and responsiveness.
Coordinate and schedule provider site visits and compliance reviews.
Conduct provider compliance reviews in accordance with applicable regulations and program requirements.
Communicate review requirements and expectations to providers.
Conduct informational provider interviews.
Assess provider operations and business practices for compliance.
Review provider records and supporting documentation.
Collect documentation and evidence supporting compliance findings.
Convert hard-copy records into electronic formats for submission through web-based systems.
Maintain accurate and organized records of review activities.
Evaluate provider sites for compliance with oversight requirements.
Document and summarize compliance findings.
Identify trends involving non-compliance and operational deficiencies.
Provide timely recommendations to project leadership and management.
Assist with ongoing quality improvement initiatives.