Provider Network Specialist - devoted

Job Description

MUST BE LOCATED IN GEORGIA

A bit about the role….

This highly impactful role will analyze provider demographic information, financial data, quality reports, and special project data. A key responsibility is supporting the performance team in preparing for and executing monthly provider performance meetings, ensuring insights are actionable and aligned with performance goals. The ideal candidate brings a strong understanding of data analysis , claims payment processes, provider setup, and root cause analysis, with a clear focus on improving provider engagement. Success in this role requires the ability to work both independently and collaboratively, strong organizational discipline, and a results-driven mindset.

Key Responsibilities and Impact

Provider Performance Audits

Conduct in-depth audits across provider performance systems, including Orinoco (demographics and fee schedules), online search tools, print directories, Looker reports, and claims payment processes. Evaluate data through a performance lens to identify gaps, inefficiencies, and root causes impacting provider performance. Deliver clear, actionable insights and partner with the performance team to implement improvements that enhance overall provider effectiveness.

Field Performance Support and Issue Resolution

Support Field Performance initiatives by engaging directly with providers to resolve provider-related issues. Ensure timely resolution and clear documentation.

​Provider Onboarding

Manage the full contract lifecycle while maintaining a focus on onboarding high-performing providers and improving overall engagement.

​Performance Reporting and Operational Support (JOC)

Partner with Performance Managers to prepare for monthly performance meetings by pulling data by leveraging AI-driven prompts with a strong emphasis on advanced AI tools and preparing slide decks and follow up items from previous meetings .

Required Skills and Experience:

A minimum of 3 years of healthcare experience, preferably in Medicare Advantage or similar environments

5 years of direct provider interaction experience

Demonstrated ability to manage detailed, performance-driven work

Proficiency in Google or MS Suite Workspace applications.

Experience in claims research, provider setup, root cause analysis, and process improvement with a focus on provider engagement

Strong written and oral communication skills

Desired Skills and Experience

Organized and detail oriented

Ability to effectively manage competing priorities and ambiguity is essential

Ability to gather, read, analyze, and interpret complex data and create accurate meaningful information for data reporting

Ability to facilitate meetings, and make presentations before groups of management and staff.

Additional Information

Remote Role - must reside in (Georgia )