Provider Network Specialist (Healthcare)

TL;DR

Provider Network Specialist (Healthcare): Analyzing provider demographics, financial data, and quality reports to improve provider engagement and network performance with an accent on data-driven audits and performance meeting preparation. Focus on conducting root cause analysis, managing contract lifecycles, and leveraging AI tools for operational reporting.

Location: Must reside in Georgia, USA (Fully Remote, with 10-15% travel to offices required)

Company

hirify.global is a healthcare organization on a mission to improve the well-being of older Americans using an integrated care platform that merges advanced data and AI with clinical expertise.

What you will do

• Conduct in-depth audits of provider performance systems, including demographics, fee schedules, and claims payment processes.
• Identify data gaps and inefficiencies to deliver actionable insights that enhance overall provider effectiveness.
• Engage directly with providers to resolve issues and support Field Performance initiatives.
• Manage the full contract lifecycle, focusing on onboarding high-performing providers and increasing engagement.
• Partner with Performance Managers to prepare monthly data and slide decks using advanced AI-driven prompts and Looker reports.

Requirements

• Must be located in Georgia.
• Minimum 3 years of healthcare experience, preferably in Medicare Advantage.
• 5 years of experience in direct provider interaction.
• Proficiency in claims research, provider setup, root cause analysis, and process improvement.
• Strong proficiency in Google or MS Suite Workspace applications.
• Strong written and oral communication skills.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and a parental leave program.
• $100 monthly stipend for mobile or internet expenses.
• Stock options provided to all employees.
• Bonus eligibility and 401K program.