Provider Network Specialist

Responsibilities Communicate proactively with both prospective and existing providers to meet evolving business needs. Guide providers through the full onboarding process, including application, credentialing, and contracting. Conduct in-person site visits with prospective providers, as required by plan standards. Lead new provider orientations and deliver ongoing training sessions to ensure continued compliance and engagement. Build and maintain strong, collaborative relationships with providers, office staff, and key stakeholders. Maintain an up-to-date directory of contacts across functional areas such as Managed Care, Credentialing, Claims, Contracting, Quality, and Population Health. Oversee a designated geographic territory, managing strategic provider partnerships and collaborating with internal family health centers and marketing staff. Serve as the primary liaison for providers, offering guidance on plan policies, directory accuracy, claims procedures, and other operational inquiries. Schedule and conduct regular office and facility visits with high-volume providers in alignment with departmental goals. Address and resolve provider inquiries related to credentialing, contract terms, reimbursement, claims, access standards, member eligibility, and reporting requirements. Accurately document and monitor provider issues, ensuring timely resolution in line with plan policies. Coordinate cross-departmental efforts to resolve complex provider concerns and identify trends for process improvement. Schedule: Monday-Friday 9:00am-5:00pm Hybrid structure - Tuesday & Thursday in office in NYC. 1-2 days/week will be in the field visiting providers onsite. Network Specialist will have full autonomy over how onsite visits are scheduled. The remainder of week not spent in office or in the field will be work from home.

Created: 2026-03-04