Provider Relations Specialist – CCE, Network Support

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

📋 Description

• Act as the main point of contact for Provider Services for designated Clinical Centers of Excellence (CCEs).

• Cultivate relationships and comprehend the operational and provider-network needs of CCEs.

• Perform regular outreach to uncover provider issues, access challenges, emerging requirements, and opportunities for service enhancement.

• Assist with CCE provider nominations and referrals through documentation, research, tracking, and routing.

• Collaborate with Provider Network/Contracting personnel regarding practitioners, specialists, facilities, and HDOs essential for member access or continuity of care.

• Deliver status updates on provider nominations, affiliations, onboarding, and Provider Services activities.

• Facilitate communication between CCEs and Provider Services regarding provider participation and operational challenges.

• Assist providers and HDOs with WTCHP requirements, operational processes, portal usage, Terms & Conditions, roster submissions, EFT, enrollment, and ongoing participation.

• Educate providers and CCE stakeholders on WTCHP processes, policies, workflows, and changes in network participation.

• Coordinate provider onboarding and orientation initiatives.

• Investigate and resolve escalated provider issues, including recurring or systemic problems.

• Collaborate with Provider Data, Credentialing, Claims, Contracting/Recruitment, and other operational teams while maintaining communication ownership.

• Identify patterns in inquiries, escalations, access issues, and administrative obstacles for Provider Services leadership.

• Maintain documentation in workflow and tracking systems, including JIRA where relevant.

• Participate in CCE meetings, operational workgroups, provider education sessions, and stakeholder forums.

• Assist with reporting on CCE engagement, provider nominations, unresolved issues, network access challenges, and resolution turnaround times.

• Promote a high-touch service model that ensures uninterrupted access to care for WTCHP members.

⛳️ Requirements

• A minimum of 3 years of relevant experience.

• At least three years of experience in provider relations, provider services, healthcare operations, health plan operations, network management, or a related healthcare setting.

• A Bachelor’s degree is preferred or an equivalent combination of education and relevant professional experience.

• Direct experience working with provider organizations, hospitals, medical groups, clinical practices, or healthcare program stakeholders is strongly preferred.

• Familiarity with provider enrollment, credentialing, provider data, contracting/participation, claims, and provider lifecycle processes.

• Excellent relationship management, communication, presentation, problem-solving, and follow-through abilities.

• Capability to coordinate issues across various operational departments while maintaining ownership of the stakeholder experience.

• Proficient in managing multiple priorities, tracking open items to resolution, and effectively communicating with both internal and external stakeholders.

• Proficiency in Microsoft Office applications is preferred.

• Experience with workflow, CRM, ticketing, or provider management systems is preferred.

• US citizenship is not a requirement.

• Must currently hold no clearance and be able to obtain no clearance.

• MBI (T2) public trust or other requirement.

🏝️ Benefits

• Comprehensive benefits and wellness packages.

• 401K with company matching.

• Competitive salary.

• Paid time off.

• AI-powered career tool that identifies career pathways and learning opportunities.

• Internal mobility team dedicated to career aspirations.

• Various medical plan options, some of which include Health Savings Accounts.

• Dental plan options available.

• Vision plan options available.

• Full flex work weeks when feasible.

• Leave for vacation, sickness, personal time, holidays, paid parental leave, military leave, bereavement, and jury duty.

• 15 days of paid leave per calendar year for new employees, prorated based on the hire date.

• 10 paid holidays per year, prorated based on the hire date.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• An award-winning culture of innovation.

• A military-friendly workplace.