Provider Network Relationship Specialist II
About The Position
The Provider Network Relationship Specialist II strengthens Medica’s network by developing and maintaining effective relationships with assigned providers or vendors, supporting member access, affordability, and service reliability. The role supports network adequacy and readiness by focusing on issue resolution, coordinating change communication and enabling smooth onboarding and ongoing engagement. It advances provider or vendor experience and operational consistency through clear communication, coordinated issue resolution, and accurate provider or vendor data. The Specialist operates with limited supervision and applies developing decision-making authority, with some creativity and latitude, to support team and organizational objectives. Performs other duties as assigned.
Requirements
- Bachelor's degree or equivalent experience in related field
- 3+ years of work experience beyond degree
- Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
Nice To Haves
- Experience in a call center or customer service environment.
- Experience in provider relations, claims, billing, or insurance operations.
- Familiarity with provider networks and healthcare regulations.
- Knowledge of healthcare provider contracting and credentialing processes.
- Proficiency in handling provider inquiries through various channels.
- Strong communication and interpersonal skills; team oriented.
- Ability to navigate multiple claims systems and understand member contracts.
- Ability to manage multiple priorities and work independently.
Responsibilities
- Serve as the primary point of contact for assigned providers or vendors, fostering trust, responsiveness, and partnership.
- Coordinate communications on program rollouts, policy updates, and operational changes to support provider readiness.
- Gather provider or vendor feedback and surface trends to internal partners to improve experience and performance.
- Maintain regular touchpoints to reinforce expectations, clarify processes, and support mutual goals.
- Deliver ongoing education regarding operational changes and workflows.
- Intake provider or vendor requests for inclusion in assigned territories and triage to ensure the appropriate network needs and adequacy considerations are achieved.
- Recommend participation decisions and document rationale consistent with policies and standards.
- Monitor inclusion decisions to ensure network readiness and member access.
- Manage escalated provider or vendor issues by coordinating with internal partners to research, resolve, and communicate outcomes.
- Support provider or vendor appeals by collecting facts, organizing documentation, and facilitating timely responses.
- Identify root causes of recurring issues and recommend process or communication improvements.
- Maintain accurate case records to inform trend analysis and continuous improvement.
- Validate accurate provider or vendor demographic and participation data across systems for issue resolution.
- Escalate discrepancies and coordinate corrections with data management and operational teams for issue resolution.
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
