Provider Network Specialist

5 years of direct provider interaction experience

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

Organized and detail oriented

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

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.

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.