Provider Network Specialist

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