Provider Network Specialist (NY/CT)

• Actively communicate with prospective and contracted providers based on business needs.
• Guide prospective providers through the application, credentialing, contracting, and onboarding processes.
• Conduct prospective provider site visits, as applicable.
• Facilitate new provider orientations and ongoing provider education and training.
• Foster and maintain positive provider network relationships.
• Develop and strengthen relationships with providers, office staff, and key stakeholders.
• Maintain accurate provider contact information, including key contacts within credentialing, claims, contracting, quality, population health, and provider operations.
• Manage an assigned provider territory, including strategic network partnerships and provider engagement initiatives.
• Serve as a primary point of contact for providers, offering support regarding network participation, provider resources, directory accuracy, operational processes, claims inquiries, and reimbursement questions.
• Schedule and conduct provider office and facility visits in accordance with departmental goals and outreach initiatives.
• Investigate, resolve, and respond to provider inquiries related to participation requirements, credentialing status, contract terms, reimbursement, claims, utilization, access and availability standards, member eligibility, and provider data management.
• Document, track, and monitor provider issues through resolution in accordance with organizational policies and procedures.
• Collaborate across departments to resolve complex provider concerns and identify trends impacting provider satisfaction and network performance.
• Partner with business development, marketing, and community outreach teams to support network growth and provider engagement efforts.
• Prepare and analyze reports related to network adequacy, provider access, and network performance.
• Monitor provider contract performance and network effectiveness through site visits, claims data, and performance analytics.
• Support quality improvement initiatives and ensure compliance with applicable regulatory and organizational standards.
• Collaborate with Quality and Population Health teams to promote quality measures, improve provider performance, and enhance patient outcomes.
• Perform additional duties and special projects as assigned., * Monday-Friday, 9:00 AM - 5:00 PM (35-hour work week).
• During the first 4-5 months, the schedule will be hybrid:
• Monday and Friday: Remote
• Tuesday, Wednesday, and Thursday: In-office (in Manhattan)
• Following the onboarding and training period (approximately 4-5 months), the hybrid schedule will remain in place; however, the role will also include in-person provider visits and meetings.
• Monday and Friday: Remote work and/or field-based provider visits
• Tuesday, Wednesday, and Thursday: In-office

• Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, Access, and Salesforce.
• Strong organizational skills with exceptional attention to detail.
• Effective presentation and public speaking skills.
• Accurate and efficient data entry and record management abilities.
• Ability to manage multiple priorities, adapt to changing business needs, and meet strict deadlines.
• Strong verbal and written communication skills, with excellent analytical and problem-solving abilities.
• Knowledge of healthcare, medical, and managed care terminology.
• Must have a car and valid drivers license

Pulled from the full job description

• 401(k)
• Vision insurance
• Dental insurance
• Paid sick time
• Life insurance
• Disability insurance, * Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)
• Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)
• 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)
• Short Term Disability Insurance
• Term Life Insurance Plan

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

Are you ready to give your career a boost by bringing your talents and expertise to some of the nation’s top companies? At Medix, we are dedicated to creating opportunities for talent through our Healthcare, Scientific and Information Technology divisions. Our dedicated recruiters offer a personalized service to make sure we truly understand your employment needs.