Provider Network Specialist Full Time

We are seeking a detail-oriented and proactive Provider Network Specialist to join our team. In this role, you will be instrumental in expanding and maintaining our network of healthcare providers (hospitals, clinics, and individual practitioners). You will manage the end-to-end provider lifecycle—from credentialing and contracting to onboarding and compliance—ensuring our clients have access to high-quality, cost-effective care. The ideal candidate has strong negotiation skills, a deep understanding of healthcare regulations, and the ability to build lasting relationships with medical providers.

Responsibilities

• Network Development & Maintenance: Identifying and recruiting qualified healthcare providers to join the network to ensure adequate geographic coverage and specialty access for plan members.
• Contract Negotiation: Assisting in the negotiation of fee schedules and service agreements with providers, ensuring rates are competitive and align with client plan designs.
• Credentialing & Enrollment: Overseeing the verification of provider licenses, certifications, and malpractice history (credentialing) and managing their enrollment into the network database.
• Claims & Billing Support: Acting as a liaison to resolve billing disputes, investigate potential fraud/waste/abuse, and ensure providers are paid correctly according to the negotiated contracts.
• Compliance: Ensuring all network activities comply with state and federal regulations (e.g., ACA network adequacy standards, HIPAA).
• Provider Relations: Serving as the primary point of contact for providers regarding network status, payment issues, and updates to plan benefits.

Qualifications

* Bachelor’s degree in a relevant field.

* Previous experience in Provider Network, Medical Insurance, or Healthcare Management is preferred.

* Strong communication and negotiation skills.

* Excellent organizational and problem-solving abilities.

* Proficiency in Microsoft Office applications.

* Ability to work effectively in a fast-paced environment.

📧 *Apply Now:* [hr@mediconsulteg.com]

(Kindly mention “Provider Network Specialist” in the subject line)