Provider Relations Specialist – CCE & Network Support

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

MBI (T2)

Job Family:

Process and Operational Efficiency

Job Qualifications:

Skills:

Health Insurance Claims, Insurance Claims, Project Management

Certifications:

None

Experience:

3 + years of related experience

US Citizenship Required:

No

Job Description:

GDIT's Federal Health Division is hiring a Provider Relations Specialist to support the World Trade Center Health Program (WTCHP).

This position is a Provider Relations role with a dedicated CCE and network-support emphasis. The specialist owns the CCE/provider relationship, intake, coordination, communication, and follow-through.

The Provider Relations Specialist – CCE & Network Support serves as a key liaison between the World Trade Center Health Program (WTCHP), Clinical Centers of Excellence (CCEs), healthcare delivery organizations (HDOs), and participating practitioners within the New York Metropolitan Area network.

This position supports the unique operational needs of the CCEs by helping ensure that providers required to support WTCHP members are appropriately identified, affiliated, onboarded, and supported. The Specialist works closely with CCE contacts to address provider access needs, facilitate provider nominations and network participation, resolve provider-related operational issues, and maintain strong communication between the CCEs and Provider Services.

The role requires a strong provider-service orientation and the ability to translate CCE needs into actionable Provider Services activities while coordinating across Provider Data, Credentialing, Contracting/Recruitment, Claims, and other operational teams.

WHAT YOU'LL BE DOING:

• Serve as a primary Provider Services point of contact for assigned CCEs, developing strong working relationships and understanding each CCE's provider network and operational needs.

• Conduct regular outreach and engagement with CCE representatives to identify provider concerns, access issues, emerging needs, and opportunities for service improvement.

• Support CCE provider nominations and referrals, ensuring requests are appropriately documented, researched, tracked, and routed through the provider affiliation and recruitment process.

• Coordinate with Provider Network/Contracting staff when CCEs identify practitioners, specialists, facilities, or HDOs needed to support member access or continuity of care.

• Provide CCEs with appropriate status updates regarding provider nominations, affiliation, onboarding, and other Provider Services activities.

• Facilitate communication between CCEs and Provider Services when provider participation or operational issues require additional research or cross-functional intervention.

• ·Support participating providers and HDOs with WTCHP requirements, operational processes, portal utilization, Terms & Conditions, roster submission, EFT, enrollment, and ongoing participation requirements.

• Educate providers and CCE stakeholders regarding WTCHP provider processes, policies, workflows, and changes affecting network participation.

• Coordinate provider onboarding and orientation activities to ensure newly affiliated organizations and practitioners understand WTCHP requirements and available resources.

• Research and facilitate resolution of escalated provider issues that cannot be resolved through standard first-call resolution, including recurring or systemic concerns affecting CCE/provider relationships.

• Partner with Provider Data, Credentialing, Claims, Contracting/Recruitment, and other operational teams to facilitate resolution while maintaining ownership of communication back to the CCE or provider.

• Identify trends in CCE inquiries, provider escalations, access concerns, and administrative barriers and elevate findings to Provider Services leadership.

• Maintain accurate documentation of CCE interactions, provider outreach, nominations, escalations, and follow-up activities within designated workflow and tracking systems, including JIRA where applicable.

• Participate in CCE meetings, operational workgroups, provider education sessions, and other stakeholder forums as assigned.

• Support reporting related to CCE engagement, provider nominations, outstanding provider issues, network access concerns, and resolution turnaround times.

• Promote a high-touch service model designed to reduce administrative abrasion for CCEs and providers while supporting uninterrupted access to care for WTCHP members.

WHAT YOU'LL NEED TO SUCCEED:

• Bachelor's degree preferred or equivalent combination of education and relevant professional experience.
• Three (3) or more years of experience in provider relations, provider services, healthcare operations, health plan operations, network management, or a related healthcare environment. Experience working directly with provider organizations, hospitals, medical groups, clinical practices, or healthcare program stakeholders strongly preferred.
• Working knowledge of provider enrollment, credentialing, provider data, contracting/participation, claims, and provider lifecycle processes.
• Strong relationship-management, communication, presentation, problem-solving, and follow-through skills.
• Demonstrated ability to coordinate issues across multiple operational departments while maintaining ownership of the stakeholder experience.
• Ability to manage multiple priorities, track open items through resolution, and communicate effectively with internal and external stakeholders.
• Proficiency with Microsoft Office applications and experience with workflow, CRM, ticketing, or provider management systems preferred.

The likely salary range for this position is $85,093 - $97,856. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employees date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.