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