Provider Network Support

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze provider rosters and network data to pinpoint deficiencies in specialty coverage, geographic accessibility, appointment availability, and credentialing status.

• Collaborate with network and clinical stakeholders to verify data and monitor remediation efforts.

• Create and maintain analyses of provider capacity, enrollment dashboards, status reports, and materials for leadership briefings.

• Evaluate provider enrollment and credentialing workflows, metrics, delays, and compliance issues, offering practical improvement recommendations.

• Assist in provider recruitment, communication, training, and the prioritization of credentialing activities.

• Offer consultative support for network-related escalations and help to identify qualified providers to meet member care requirements.

• Facilitate single case agreements and letters of agreement via established review and approval processes.

• Perform quality reviews and audits of provider files and network processes, document findings, and monitor corrective actions.

• Create or revise SOPs, process maps, training materials, templates, and other resources for knowledge management.

• Engage in program meetings, document decisions and action items, and coordinate follow-up with responsible stakeholders.

• Protect member, provider, and program information in compliance with relevant privacy, security, and records management regulations.

⛳️ Requirements

• Experience in supporting provider network operations, provider enrollment, credentialing, healthcare operations, managed care, or a related area.

• Capability to analyze operational data, identify gaps or trends, and convert findings into actionable recommendations.

• Experience in developing dashboards, reports, process documentation, or briefing materials.

• Strong organizational, analytical, problem-solving, written communication, and stakeholder coordination abilities.

• Proficient in managing recurring deliverables, maintaining accurate documentation, and tracking issues until resolution.

• Ability to handle sensitive healthcare and provider information with discretion.

• Proficiency in MS Office: Word, Excel, PowerPoint, and Outlook.

• Familiarity with communication tools such as Teams and SharePoint.

🏝️ Benefits

• Paid leave

• Employer-sponsored group medical insurance options

• Dental insurance options

• Vision insurance options

• Short-term disability insurance

• Long-term disability insurance

• Life insurance

• AD&D coverage

• Legal services

• Identity theft insurance

• Accident insurance

• Flexible spending account options with pre-tax savings

• Health savings account options with pre-tax savings

• Employer contribution match through the company-sponsored 401(k) retirement plan; immediately vested

• Professional courses

• Certifications

• Tuition reimbursement programs