Provider Network Specialist

KHS•Bakersfield, CA

3d•$29 - $36

About The Position

Under general direction of the Provider Engagement Manager, the Provider Network Specialist is responsible for assigned duties and activities in the Provider Network Management Department. The Specialist assist the Provider Engagement Manager in building out provider communications, satisfaction surveys, and education programs to ensure providers are well-informed, supported, and compliant with regulatory requirements. This position also serves as the primary liaison for the Enhanced Care Management (ECM) and Community Support Services (CSS) provider network. In addition to this, this position supports provider recruitment, engagement, grievance resolution, provider education, and portal training. This position is responsible for the assigned duties in the Provider Network Management Department for a Knox-Keene licensed health care maintenance organization which includes daily contact with network providers to establish and maintain relationships beneficial to the Plan, the Providers and the Members.

Requirements

A bachelor’s degree in business administration, Healthcare, or a related field.
One year of experience in healthcare required.
OR
4 years of professional experience in healthcare required.
Required travel up to 40%.
Possession of valid California Driver’s License and proof of valid State required auto liability insurance.

Responsibilities

Professional, ethical and respectable representation of Kern Health Systems to the Provider community.
Possess, and demonstrate full understanding of the various provider contracts maintained by KHS.
Maintain and document all types of provider contacts and communications in appropriate system(s).
Assist with developing tracking spreadsheet with detailed data, performing data analysis, generating reports, documentation and project evaluation purposes.
Collaborate with Provider Network Analysts and other departments to identify network gaps for concentrated recruitment activities.
Work with Contracting Specialists and Provider Relations Representatives to promote seamless contracting and onboarding.
Support grievance resolution processes by coordinating provider responses and ensuring compliance with regulatory requirements.
Engage ECM and CSS providers to ensure appropriate network participation and member access.
Conduct provider portal trainings (new user onboarding, authorization submission guidance, refresher sessions).
Communicate with providers regarding claims issues and coordinate outreach with contracting staff
Attend daily operational meetings with ECM and CSS teams to ensure provider support and integration.
Assist with provider communications, including newsletters, bulletins, provider manual updates, and other educational materials.
Support provider education forums, webinars, orientations, and training programs; ensure onboarding is conducted in accordance with regulatory standards.
Coordinate provider satisfaction survey activities; track survey results and assist in developing action plans to improve provider experience.
Assists management staff in completing Provider Network Management related projects as assigned.
Interfaces with other departments in the development, preparation and distribution of provider and/member reports.
Travel independently to conduct provider visits with own reliable transportation.
Adheres to all company policies and procedures relative to employment and job responsibilities.
Performs other job-related duties as assigned.