Background Investigation, Business Administration, Communication Skills, Data Analysis, Driver's License, Health Maintenance Organization (HMO), Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Improvement Metrics, Medicare, Negotiation Skills, Network Administration/Management, Network Support, Onboarding, Performance Analysis, Performance Management, Performance Metrics, Presentation/Verbal Skills, Primary Care, Problem Solving Skills, Provider Contracting, Provider Relations, Quality Management, Relationship Management, Risk, Salesforce.com, Training/Teaching, Utilization Management, Willing to Travel, Work From Home
Provider Engagement Specialist
Location: Triad Region, North Carolina (Winston-Salem, Greensboro, Burlington)
Work Environment: Field-Based | Up to 80% Travel (Local Market)
Overview
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.
Key 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
Experience
Required
- 1+ year of experience in:
- Provider Relations
- Provider Contracting
- Network Management
- Healthcare Organization (HMO, IPA, Medical Group)
- Strong understanding of:
- HEDIS
- Stars
- Risk Adjustment
- MLR
- Proven ability to build and manage provider relationships independently
- Strong communication and presentation skills
- Valid driver’s license and reliable transportation
Preferred
- 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
The pay range may be based on several factors, including market location, education, responsibilities, and experience.
Application Requirements
• Must be legally authorized to work in the United States
• Candidates must be willing to submit to a background check and drug screening, if required
• Candidates will be asked to provide their home address and complete employment eligibility questions during the application process
• Valid driver's license and reliable transportation required