Provider Network Specialist

About the Role

Minimum Qualifications

• Bachelor’s degree in healthcare administration, business, or a related field.
• Minimum of 2 years experience in provider network management or healthcare contracting.
• Strong knowledge of healthcare provider types, insurance products, and regulatory requirements.
• Proficiency with data analysis and network management software.
• Excellent communication and negotiation skills.
• Relevant experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications

• Experience working within a managed care organization or health plan.
• Familiarity with provider credentialing processes and standards.
• Advanced skills in data analytics tools such as Excel, SQL, or business intelligence platforms.
• Certification in healthcare contracting or network management (e.g., CPHQ, CNE).
• Knowledge of federal and state healthcare regulations impacting provider networks.

Responsibilities

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
• Builds and maintains positive, professional relationships with contracted and subcontracted providers by supporting provider engagement initiatives, serving as a trusted liaison, addressing provider concerns, and promoting provider satisfaction through responsive and collaborative service.
• Coordinates provider onboarding, orientation, and operational integration activities while ensuring providers understand organizational workflows, documentation standards, operational expectations, and service delivery requirements.
• Develops and delivers timely, accurate provider communications and educational resources related to organizational policies, operational changes, compliance requirements, workflow expectations, quality initiatives, and program updates.
• Responds to provider inquiries, complaints, and operational concerns in a timely, professional, and solution-oriented manner by coordinating appropriate follow-up activities, tracking resolutions, and promoting positive provider experiences.
• Maintains accurate provider records and operational tracking tools while compiling, validating, analyzing, and reporting provider performance data, operational metrics, provider trends, and engagement activities to support informed decision-making.
• Collaborates effectively with Operations, Clinical, Quality, Compliance, Credentialing, Care Management, Claims, Provider Network, and other cross-functional teams to support organizational objectives, provider success, and high-quality member care.
• Maintains organized documentation, monitors provider-related action items, escalations, and operational activities, and consistently demonstrates accountability by ensuring work is completed accurately, timely, and in accordance with organizational standards.
• Supports compliance with applicable federal, state, health plan, contractual, and organizational requirements by assisting with audits, delegated oversight activities, operational reviews, corrective action plans, and provider-related compliance initiatives.
• Performs other duties as required or assigned.