Remote Provider Engagement Specialist (North Carolina)

Key Responsibilities

• Build and maintain collaborative relationships with providers, office staff, and key stakeholders to support network growth and performance
• Conduct provider onboarding, orientations, and ongoing education initiatives
• Analyze provider performance data and deliver actionable insights to optimize outcomes
• Educate providers on HEDIS, Stars, Risk Adjustment, and documentation/coding requirements
• Develop and implement provider engagement strategies to improve quality scores and member experience
• Serve as a primary point of contact for provider inquiries, ensuring timely resolution
• Support resolution of provider issues related to access, claims, eligibility, and utilization management
• Create and deliver training materials, in-service presentations, and Model of Care trainings
• Maintain accurate provider data and activity tracking in Salesforce and internal systems
• Support provider recruitment, contracting, and credentialing processes
• Negotiate and implement provider agreements in assigned markets
• Track recruitment and contracting activity and provide regular reporting
• Exercise independent judgment and decision-making on complex issues with minimal supervision

Experience Required

• Minimum 1 year of experience in provider relations, contracting, or network management within an HMO, IPA, medical group, or healthcare organization
• Preferred: 2+ years of provider-facing experience, including Medicare lines of business
• Strong understanding of HEDIS, Stars, Risk Adjustment, and MLR

Education Required

• High School Diploma or GED (Bachelor’s degree or equivalent experience preferred)

Skills & Competencies

• Strong communication and relationship-building skills
• Ability to present complex healthcare topics to providers
• Proficiency in Microsoft Office (Word, Excel, PowerPoint)
• Strong analytical, problem-solving, and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Experience analyzing and interpreting performance data and reports

Physical Requirements

• Regularly required to sit, stand, walk, and use hands for tasks
• Ability to lift up to 10 pounds occasionally
• Close vision and focus adjustment required

Work Environment & Travel

• Up to 80% travel by car within the assigned market
• Occasional air travel as needed
• Ability to work extended hours when necessary
• Remote work available with approval