Provider Network Support

Overview

Planned Systems International is seeking a Provider Network Support Specialist to help strengthen provider network access, capacity, enrollment, credentialing, compliance, and operational performance for a federal healthcare program. This role will analyze provider network data, identify coverage and capacity gaps, support provider enrollment and recruitment activities, assist with network-related case escalations, and develop reports and recommendations for program leadership. The ideal candidate is analytical, collaborative, detail-oriented, and comfortable coordinating with clinical, operational, and contractor stakeholders.

On July 1, 2011, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), WTC Health Program was established as a federal health care program to provide medical monitoring and treatment for eligible members in accordance with the James Zadroga 9/11 Health and Compensation Act of 2010. On December 18, 2015, President Obama signed the James Zadroga 9/11 Health and Compensation Reauthorization Act which reauthorized the WTC Health Program for 75 years, ending in 2090.

Essential Functions and Job Responsibilities

• Analyze provider rosters and network data to identify gaps in specialty coverage, geographic access, appointment capacity, and credentialing status.

• Coordinate with network and clinical stakeholders to validate data and track remediation activities.

• Develop and maintain provider capacity analyses, enrollment dashboards, status reports, and leadership briefing materials.

• Review provider enrollment and credentialing workflows, metrics, delays, and compliance concerns and recommend practical improvements.

• Support provider recruitment, communications, training, and credentialing prioritization activities.

• Provide consultative support for network-related escalations and help identify qualified providers for member care needs.

• Support single case agreements and letters of agreement through established review and approval processes.

• Conduct quality reviews and audits of provider files and network processes, document findings, and track corrective actions.

• Develop or update SOPs, process maps, training materials, templates, and other knowledge-management resources.

• Participate in program meetings, document decisions and action items, and coordinate follow-up with responsible stakeholders.

• Safeguard member, provider, and program information in accordance with applicable privacy, security, and records-management requirements.

Minimum Requirements

• Experience supporting provider network operations, provider enrollment, credentialing, healthcare operations, managed care, or a related function.

• Demonstrated ability to analyze operational data, identify gaps or trends, and translate findings into actionable recommendations.

• Experience developing dashboards, reports, process documentation, or briefing materials.

• Strong organizational, analytical, problem-solving, written communication, and stakeholder-coordination skills.

• Ability to manage recurring deliverables, maintain accurate documentation, and track issues through resolution.

• Ability to handle sensitive healthcare and provider information appropriately.

Additional Information

• MS Office (Word, Excel, Powerpoint, Outlook)

• Communication tools (Teams, SharePoint)

Company Benefits

PSI offers full-time, benefits eligible employees a competitive total compensation package that includes paid leave, and options for employer sponsored group medical, dental, vision, short-term and long-term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance. Flexible spending account and health saving account options offer pre-tax savings for qualified medical, dental, and vision expenses. The company sponsored 401(k) retirement plan has an employer contribution match that is immediately vested. We invest in the professional growth of our employees through professional courses, certifications, and tuition reimbursement programs.

EEO Commitment

It is company policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits, and termination, are made without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, citizenship status, veteran status, protected veteran status, disability, or any other characteristic protected by applicable federal, state, or local law.

To ensure fair and consistent consideration of all applicants, all candidates must submit a formal application through Planned Systems International's Applicant Tracking System (ATS), iCIMS. Resumes submitted via email, social media, referrals, recruiting events, or other means will not be considered an official application and must be accompanied by a completed online application in the ATS before a candidate can be considered for employment. Reasonable accommodations for applicants and employees with disabilities will be provided. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, or to receive an update regarding the status of your application, please contact Talent Acquisition by emailing [email protected], or by dialing 703-575-8400.