What are the responsibilities and job description for the Provider Network Specialist position at Medix™?
Provider Network Specialist
Overview
We are seeking a Provider Network Specialist to serve as the primary liaison between the health plan and its network of healthcare providers. This role focuses on building strong provider relationships, supporting on-boarding and education, and ensuring network adequacy and compliance. The ideal candidate is comfortable working autonomously, traveling within their territory, and collaborating cross-functionally to support high-quality care delivery and a positive provider experience.
Key Responsibilities
- Serve as the main point of contact for prospective and existing providers, addressing operational, contractual, and policy-related inquiries
- Guide providers through the full on-boarding life cycle, including application, credentialing, and contracting
- Conduct in-person site visits with providers in accordance with plan standards
- Lead new provider orientations and deliver ongoing training to ensure understanding of plan policies, programs, and contractual requirements
- Build and maintain strong relationships with providers, office staff, and key internal stakeholders
- Maintain an accurate and up-to-date directory of provider contacts across departments such as Credentialing, Claims, Contracting, Quality, Managed Care, and Population Health
- Manage a designated geographic territory, collaborating closely with internal care centers and marketing teams
- Schedule and conduct routine office visits with high-volume providers to support engagement and performance goals
- Resolve provider issues related to credentialing, reimbursement, claims, access standards, eligibility, and reporting requirements
- Document provider concerns accurately and ensure timely resolution in alignment with plan policies
- Coordinate cross-departmental efforts to address complex provider issues and identify trends for process improvement
- Partner with marketing and sales teams on outreach initiatives to expand the provider network and increase brand visibility
- Develop and present analytical reports assessing network adequacy, access gaps, and provider availability
Schedule & Work Environment
- Monday–Friday, 9:00 AM–5:00 PM
- In-office in NYC on Tuesdays and Thursdays
- Remaining days are remote or spent onsite with providers
- Travel required throughout New York and Connecticut
- Autonomous scheduling with flexibility to arrange provider visits independently
Must-Have Qualifications
- Must reside in the Tri-State area
- 3 years of experience working with health insurance and/or provider relations (must have direct provider-facing experience)
- Associate’s or Bachelor’s degree
- Valid driver’s license and access to a personal vehicle
- Ability to travel to provider sites in NY and CT 1–2 days per week
- Strong presentation and communication skills
Nice-to-Have Qualifications
- Experience conducting provider training or orientations
- Familiarity with credentialing, claims, and managed care operations
- Comfort working in a fast-paced, relationship-driven environment
What We Offer
- Strong, collaborative team culture with regular team events
- Clear opportunities for growth and advancement
- Comprehensive benefits package
Salary : $70,000 - $75,000