Provider Network Specialist

The Provider Network Specialist supports the growth and maintenance of the provider network through provider outreach, contract coordination, and provider onboarding and network participation processes. This role serves as a key liaison between providers and internal teams to ensure a smooth and timely contracting and credentialing process.

This position is ideal for someone who is organized, proactive, and comfortable working with providers and cross-functional teams to support network development and operational goals.

Major Duties and Responsibilities

Role/Responsibilities:

Provider Outreach & Network Support

• Conduct outreach to prospective providers and facilities to support network expansion and adequacy initiatives
• Prioritize outreach efforts based on identified provider gaps and network needs
• Support efforts to close network adequacy gaps through targeted provider engagement
• Serve as a primary point of contact for providers during the onboarding process

Contract Coordination

• Coordinate the distribution, tracking, and collection of provider contracts
• Serve as a liaison between providers and internal stakeholders during the contracting process
• Ensure all required documentation is received and complete prior to execution
• Track contract status and follow up as needed to move providers through the process efficiently

Credentialing Coordination

• Partner with internal teams and/or vendors to ensure credentialing activities are completed timely
• Monitor provider progress through the credentialing process and proactively address delays
• Ensure required documentation is obtained and submitted to support credentialing completion
• Help maintain compliance with internal standards and turnaround expectations

Provider Terminations & Member Communications

• Coordinate activities related to provider terminations from the network
• Track and support member notification requirements for affected members
• Partner with internal teams to ensure notifications are completed accurately and within required timeframes

Cross-Functional Collaboration

• Work closely with network management, credentialing, operations, and other teams to support provider onboarding
• Assist with resolving provider issues or barriers related to contracting or credentialing
• Support internal reporting and tracking related to provider onboarding and network status
• Partner with internal teams to support network adequacy goals and ongoing access requirements

Do you have a valid Certified Provider Credentialing Specialist certification?, Do you have experience in Productivity software?, * 2+ years of experience in healthcare, provider relations, network operations, or credentialing

• Familiarity with provider contracting or credentialing processes
• Ability to follow up consistently and manage timelines effectively
• Experience with a health plan, managed care organization, or Medicare Advantage
• Experience working with credentialing vendors (CVOs) or provider data systems preferred
• Understanding of provider network development or adequacy concepts

Specialized Skills/Knowledge

• Proficiency in Microsoft Excel and general office application
• Ability to adapt to a fast paced, continually changing business and work environment while managing multiple priorities.
• Requires strong attention to detail and follow-through
• Regular interaction with providers and internal stakeholders
• Excellent communication skills (written and verbal)
• Strong organizational skills with the ability to manage multiple providers and tasks simultaneously, * Do you have a contract management certification
• Do you have healthcare plan experience

Language:

• English (Required)

License/Certification:

• Certified Provider Credentialing Specialist (Preferred)

3.03.0 out of 5 stars Remote $58,000 - $65,000 a year - Full-time, Pulled from the full job description

• 401(k)
• Health insurance
• 401(k) matching
• Paid time off
• Vision insurance
• Dental insurance, Salary will be commensurate with length and complexity of experience in Provider Network Specialist roles. Salaried position provides full benefits package, including but not limited to BCBSAL health insurance, 401k, paid vacation, and personal days.

Job Type: Full-time

Pay: $58,000.00 - $65,000.00 per year, * 401(k)

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Associated Care Ventures, Inc. (ACV) is the Birmingham-based parent company of Simpra Advantage, Inc., an Alabama domiciled insurance company operating an Institutional Special Needs Plan, a Dual Eligible Special Needs Plan, and an Institutional Equivalent Special Needs Plan. ACV is the parent company of Alabama Select Network, LLC, which is operating an Integrated Care Network for the Alabama Medicaid Agency, to coordinate Medicare and Medicaid services state-wide for eligible individuals receiving long term services and supports, both living at home and in nursing facilities.