Provider Engagement Specialist – Medicare Advantage | Wake County, NC
Core
Develop and maintain strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth for seniors and chronically ill patients.
Role type
Provider Engagement Specialist (Medicare Advantage)
Builds
Provider networks and performance metrics for a Medicare Advantage plan
Domain
Healthcare / Medicare Advantage
Required skills
Provider relations, contracting, HMO/IPA experience, KPI management, provider onboarding, training material development, claims/eligibility resolution, negotiation, credentialing, data analysis, MS Office proficiency
Preferred skills
Bilingualism, self-starter, strong presentation skills
Technologies
MS Office suite (Word, Excel, PowerPoint), network databases
Responsibilities
Build collaborative relationships with providers to support growth and retention; Partner with providers to improve performance on KPIs including growth, retention, AWVs, HEDIS, and utilization; Conduct provider onboarding and education; Facilitate resolution for provider issues like UM, prior authorization, and claims; Represent the company at provider meetings and events; Maintain department databases and tracking tools; Negotiate physician agreements and obtain credentialing; Submit weekly activity summaries.
Seniority
Mid-level, hands-on IC