Provider Network SpecialistDepartment: Provider Relations
Employment Type: Full Time
Location: Remote - NorCal
Reporting To: Tu Nguyen
Compensation: $85,000 - $92,500 / year
DescriptionThe Provider Network Specialist supports the operational administration of the provider network by coordinating provider onboarding, demographic maintenance, network documentation, provider data accuracy, and cross-functional operational workflows. This role works closely with Provider Relations, Contracting, Credentialing, Provider Data Management, and Market Operations to ensure timely and accurate execution of provider network activities.
The Provider Network Specialist plays a key role in maintaining network integrity and supporting efficient provider lifecycle processes throughout the San Jose/Santa Clara County Market.
What You'll DoProvider Network Administration- Coordinate provider onboarding activities with internal departments.
- Monitor onboarding progress and follow up on outstanding requirements.
- Assist with provider demographic updates, additions, and terminations.
- Coordinate provider roster maintenance and network records.
Provider Data Management- Maintain provider information within internal databases and tracking systems.
- Verify provider demographic information for completeness and accuracy.
- Assist with provider directory maintenance and reconciliation activities.
- Monitor provider documentation requirements.
Operational Coordination- Coordinate provider contracting and credentialing workflow activities.
- Track provider implementation milestones and required documentation.
- Monitor operational work queues and assigned tasks.
- Prepare operational reports and status updates.
Cross-Functional Support- Coordinate activities among Provider Relations, Contracting, Credentialing, PDM, Claims, and Operations.
- Support implementation of provider network initiatives.
- Assist with audit preparation and documentation requests.
Reporting & Documentation- Maintain provider tracking reports.
- Prepare operational summaries and dashboards.
- Organize provider files and documentation.
- Perform other duties as assigned.
QualificationsEducation- High school diploma or equivalent required.
- Equivalent healthcare experience may be substituted.
Experience:- 2-3 years of healthcare operations, provider network operations, credentialing, contracting, provider data management, IPA, ACO, MSO, or managed care experience.
You're great for the role if: - Experience coordinating provider operational activities.
- Associate degree preferred.
Knowledge, Skills, and Abilities - Knowledge of provider lifecycle processes.
- Understanding of credentialing, contracting, and provider data management.
- Strong organizational skills.
- Strong attention to detail.
- Ability to manage multiple priorities.
- Microsoft Office proficiency, including Excel.
- Strong written and verbal communication skills.
- Ability to work collaboratively across departments.
- Ability to travel locally as needed.
Environmental Job Requirements and Working Conditions- This is a hybrid position requiring work in both an office environment and provider offices throughout the San Jose / Santa Clara County Market. Regular local travel is required to support provider onboarding, operational coordination, and market activities. The role involves prolonged computer use, frequent interaction with internal stakeholders and provider offices, and occasional attendance at meetings or company events as business needs require.
- The national target pay range for this role is $85,000 - $92,500 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
