Provider Services Lead

As the Provider Services Lead, you will play a crucial role in managing provider enrollment, relations, and education.

• Lead the provider services operations team for the Health Program, ensuring healthcare providers receive timely support, accurate information, and necessary resources to deliver quality care.
• Serve as the primary liaison between the program, contracted clinical centers, the provider network contractor, and individual providers to address operational, administrative, and policy-related inquiries.
• Build relationships with contracted clinical centers to coordinate provider nomination requests and pursuit status, prescriber authorizations, and ongoing support for the members
• Oversee provider enrollment, onboarding, credentialing, and compliance with federal and program-specific requirements.
• Develop and maintain provider communications, including updates on policy changes, clinical guidelines, and program procedures.
• Support the secure exchange and organized management of all provider enrollment documentation, including Terms & Conditions Agreements, EFT and W9 forms, and related documentation
• Monitor provider adequacy, service delivery metrics, and satisfaction levels; recommend improvements as needed.
• Coordinate resolution of escalated provider issues in collaboration with clinical, administrative, and IT teams, including two subcontractors.
• Manage provider education and training initiatives to ensure consistent application of program standards and healthcare best practices.
• Prepare reports for leadership on provider engagement, performance, and network adequacy.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, or related field (Master’s preferred).
• 5 years of experience in provider relations, network management, or healthcare operations, preferably in a federal health or large public health program.
• Must have knowledge of provider contracting, credentialing, and compliance processes.
• Must have strong understanding of healthcare delivery systems, claims processes, and clinical operations.
• Excellent interpersonal, communication, and relationship management skills.
• Ability to analyze provider performance data and develop actionable improvement plans.
• Proficiency with provider network management tools and MS Office Suite.
• Relevant certifications such as CPCS, CPMSM, or PMP preferred.