About this role
About the Role: We are seeking a dynamic Provider Relations Specialist to support the day-to-day management of provider relationships and performance across our contracted provider network. This role serves as a key point of contact for participating providers across multiple lines of business, including Medicare Advantage, Medicaid, Marketplace, and the Medicare Shared Savings Program (MSSP) ACO. The Provider Relations Specialist is responsible for both field and office-based activities, providing education, operational support, and ongoing engagement to assigned providers and practices. A key focus of this role is partnering with providers to improve HEDIS and quality performance, close care gaps, improve appropriate utilization, manage cost trends, and support overall population health outcomes. This individual will develop strong, trusted relationships with providers and practice staff and use performance data to identify opportunities for improvement. The role requires a combination of relationship management, problem-solving, and analytical skills, with the ability to translate quality, utilization, and cost data into meaningful and actionable opportunities for providers. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Serve as the primary relationship contact for an assigned portfolio of providers across Medicare Advantage, Medicaid, Marketplace, and MSSP ACO programs. Build strong provider relationships through routine visits, education, onboarding, and ongoing support. Partner with providers to improve HEDIS performance, close care gaps, enhance quality outcomes, and support population health initiatives. Analyze provider quality, utilization, and cost-of-care performance data to identify trends and improvement opportunities. Conduct provider performance reviews and develop action plans to drive measurable results. Support provider engagement, retention, issue resolution, and network growth initiatives. Collaborate with internal teams including Quality, Population Health, Clinical Operations, Credentialing, Contracting, and Analytics to support provider success. Monitor provider performance, maintain accurate documentation, and communicate key insights, risks, and opportunities to leadership. Promote high-quality, cost-effective care while supporting value-based care objectives across contracted networks.