Provider Engagement Specialist

About the role

The Provider Engagement Specialist supports the performance and growth of the assigned market by building strong relationships with primary care and specialist providers. This is a field-based role focused on provider outreach, education, and performance improvement. You will work directly with provider offices to drive quality outcomes, improve performance metrics, and support network operations across a growing healthcare organization.

Responsibilities

• Build and maintain strong relationships with providers, office staff, and key stakeholders
• Conduct provider onboarding, orientations, and ongoing education
• Perform regular in-person provider visits to review performance and identify improvement opportunities
• Analyze provider performance data and deliver actionable insights
• Educate providers on HEDIS, Stars, Risk Adjustment, and documentation/coding requirements
• Develop and execute provider engagement strategies to improve quality scores and member outcomes
• Resolve provider issues related to claims, access, eligibility, and utilization management
• Create and deliver training materials, presentations, and Model of Care sessions
• Track provider activity and performance in Salesforce and internal systems
• Support provider recruitment, contracting, and credentialing processes
• Negotiate and implement provider agreements within the assigned market
• Serve as a primary point of contact for provider inquiries
• Participate in team initiatives and special projects

Requirements

• Minimum 1 year of experience in provider relations, contracting, or network management within an HMO, IPA, medical group, or healthcare organization
• Strong understanding of: HEDIS, Stars, Risk Adjustment, and MLR
• Proven ability to build and manage provider relationships independently
• Strong communication and presentation skills
• Valid driver’s license and reliable transportation

Qualifications

• 2+ years of provider-facing experience
• Medicare Advantage experience
• Experience working with provider performance metrics and analytics
• Bachelor’s degree (MBA a plus)

Work Environment & Travel

• Up to 80% travel within the assigned market (local driving required)
• Occasional air travel as needed
• Remote work flexibility when not in the field
• Ability to work extended hours when necessary

Pay

$54,434.00 - $81,651.00 DOE. Pay range may be based on factors such as market location, education, responsibilities, and experience.