Provider Network Support

Planned Systems International, Inc.•, Remote

About The Position

Planned Systems International is seeking a Provider Network Support Specialist to help strengthen provider network access, capacity, enrollment, credentialing, compliance, and operational performance for a federal healthcare program. This role will analyze provider network data, identify coverage and capacity gaps, support provider enrollment and recruitment activities, assist with network-related case escalations, and develop reports and recommendations for program leadership. The ideal candidate is analytical, collaborative, detail-oriented, and comfortable coordinating with clinical, operational, and contractor stakeholders. On July 1, 2011, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), WTC Health Program was established as a federal health care program to provide medical monitoring and treatment for eligible members in accordance with the James Zadroga 9/11 Health and Compensation Act of 2010. On December 18, 2015, President Obama signed the James Zadroga 9/11 Health and Compensation Reauthorization Act which reauthorized the WTC Health Program for 75 years, ending in 2090.

Requirements

Experience supporting provider network operations, provider enrollment, credentialing, healthcare operations, managed care, or a related function.
Demonstrated ability to analyze operational data, identify gaps or trends, and translate findings into actionable recommendations.
Experience developing dashboards, reports, process documentation, or briefing materials.
Strong organizational, analytical, problem-solving, written communication, and stakeholder-coordination skills.
Ability to manage recurring deliverables, maintain accurate documentation, and track issues through resolution.
Ability to handle sensitive healthcare and provider information appropriately.

Nice To Haves

MS Office (Word, Excel, Powerpoint, Outlook)
Communication tools (Teams, SharePoint)

Responsibilities

Analyze provider rosters and network data to identify gaps in specialty coverage, geographic access, appointment capacity, and credentialing status.
Coordinate with network and clinical stakeholders to validate data and track remediation activities.
Develop and maintain provider capacity analyses, enrollment dashboards, status reports, and leadership briefing materials.
Review provider enrollment and credentialing workflows, metrics, delays, and compliance concerns and recommend practical improvements.
Support provider recruitment, communications, training, and credentialing prioritization activities.
Provide consultative support for network-related escalations and help identify qualified providers for member care needs.
Support single case agreements and letters of agreement through established review and approval processes.
Conduct quality reviews and audits of provider files and network processes, document findings, and track corrective actions.
Develop or update SOPs, process maps, training materials, templates, and other knowledge-management resources.
Participate in program meetings, document decisions and action items, and coordinate follow-up with responsible stakeholders.
Safeguard member, provider, and program information in accordance with applicable privacy, security, and records-management requirements.