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).

• Build and maintain relationships while gaining insight into each CCE's provider network and operational requirements.

• Conduct outreach to uncover provider concerns, access challenges, emerging needs, and opportunities for service enhancement.

• Aid in provider nominations and referrals by documenting, researching, tracking, and managing requests.

• Collaborate with Provider Network/Contracting personnel regarding practitioners, specialists, facilities, and Health Delivery Organizations (HDOs).

• Provide updates on the status of provider nominations, affiliations, onboarding, and overall Provider Services activities.

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

• Assist providers and HDOs with WTCHP requirements, operational processes, portal usage, terms and conditions, roster submissions, electronic funds transfer (EFT), enrollment, and participation criteria.

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

• Organize provider onboarding and orientation sessions.

• Investigate and resolve escalated provider issues and systemic challenges.

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

• Identify trends in inquiries, escalations, access issues, and administrative obstacles; report findings to leadership.

• Keep comprehensive records in workflow and tracking systems, including JIRA where applicable.

• Take part in CCE meetings, operational workgroups, educational sessions, and stakeholder forums.

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

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

⛳️ Requirements

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

• At least three (3) years of experience in provider relations, provider services, healthcare operations, health plan operations, network management, or a similar healthcare setting.

• Direct experience 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 skills.

• Capability to coordinate issues across various operational departments while ensuring a positive stakeholder experience.

• Ability to handle multiple priorities, track open items to resolution, and communicate effectively 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 mandatory.

• MBI (T2) public trust requirement.

• Ability to support the New York Metropolitan Area network.

• Less than 10% travel required.

🏝️ Benefits

• Comprehensive benefits and wellness packages.

• 401K with company match.

• Competitive salary.

• Paid time off.

• Multiple medical plan options, including some with Health Savings Accounts.

• Dental plan options.

• Vision plan options.

• Full flexible work weeks where feasible.

• Vacation, sick, personal time, holiday, paid parental leave, military leave, bereavement leave, and jury duty leave.

• Typically 15 days of paid leave each calendar year.

• An additional 10 paid holidays annually.

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

• Short- and long-term disability benefits.

• Life insurance.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• AI-driven career tool that identifies career steps and learning opportunities.

• An internal mobility team dedicated to supporting career aspirations.

• An award-winning culture of innovation.

• A military-friendly workplace.

• Options for remote work and telecommuting.