Provider Network Specialist

SVCMC Inc•New York, NY

5d•$70,000 - $75,000•Hybrid

About The Position

The Provider Network Specialist is responsible for developing and maintaining positive working relationships with healthcare providers, ensuring provider satisfaction, resolving issues, and supporting network performance. This role acts as the key point of contact between providers and internal departments to ensure efficient communication and compliance with contractual and regulatory requirements.

Requirements

Associate’s degree (i.e., business management, healthcare management) OR equivalent experience.
5-8 years’ experience in health insurance, provider network or provider contracting.
Access to personal vehicle.
Valid driver’s license.
Able to lift 20 pounds.
Strong interpersonal and relationship building skills
Strong organizational skills and detail oriented
Excellent presentation skills
Excellent verbal and written communication skills
Excellent data entry skills
Ability to manage multiple priorities and meet stringent deadlines
Medical and managed care terminology
Proficiency in Microsoft Office, Access and Salesforce

Nice To Haves

Associate’s Degree Preferred

Responsibilities

Educate providers on Plan policies, procedures, billing guidelines and TRICARE requirements.
Support onboarding and orientation of newly contracted providers as well as participate in ongoing training to ensure understanding and adherence of Plan policies, programs, TRICARE requirements and contractual obligations.
Monitor network adequacy and respond appropriately; including gaps/access and availability.
Collaborate with internal departments to resolve provider issues and ensure beneficiary needs.
Assist providers with claim resolution, credentialing inquiries, contract interpretation and system navigation.
Address inquiries and resolve issues; track, trend and report provider inquiries/issues to management.
Actively communicate with prospective and contracted providers.
Conduct provider site visits (virtual or in-person) to maintain strong relationships and ensure compliance.
Maintain an accurate list of contacts, including but not limited to, Managed Care, Credentialing, Claims, Contracting, Quality and Population Health executives and/or representatives manages territory.
Maintain accurate documentation of provider interactions; track inquiries and monitor towards resolution.
Partner with marketing/sales teams and participate in outreach activities/events, targeting market growth, penetration and building brand recognition.
Analyze provider performance metrics (quality, utilization, and data analytics).
Collaborate with Quality Department (HEDIS) to help reinforce Plan quality standards and increase positive patient outcomes.
Identify trends in provider concerns and recommend process improvements.
Additional interdepartmental duties as assigned.

Benefits

Medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services.
Vision coverage through UnitedHealthcare Vision
Dental benefits through MetLife.
Basic life and disability insurance are automatically provided at no cost.
Commuter benefits
Tuition reimbursements
401(k)-retirement plan with an immediate employer match that is fully vested from day one.
Generous time off package, which includes vacation, 10 paid holidays, and 3 personal days.
Comprehensive Employee Assistance Program
Exclusive discounts through Working Advantage.