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Provider Specialist Jobs (NOW HIRING)

Wipro Limited

Provider CSR 1

Jefferson City, MO · On-site

$18 - $19/hr

Provider Specialist Provider Specialist Role Overview: We are seeking a dedicated Provider Specialist to join Infocrossing INC's BPS-IHS division, where you will serve as a vital liaison supporting ...

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$31.5K

$69.7K

$133K

How much do provider specialist jobs pay per year?

As of Sep 10, 2026, the average yearly pay for provider specialist in the United States is $69,738.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,500.00 and $84,500.00 per year, depending on experience, location, and employer.

What is a provider specialist?

A Provider Specialist is a professional who serves as a liaison between healthcare providers and insurance companies or healthcare networks. They are responsible for managing provider enrollment, credentialing, and maintaining up-to-date records to ensure compliance with regulations. Provider Specialists also handle inquiries related to provider contracts, reimbursement, and claims, supporting both providers and internal teams. Their work helps ensure that healthcare providers can deliver services efficiently within insurance or healthcare systems.

What are the key skills and qualifications needed to thrive as a provider specialist?

To thrive as a Provider Specialist, you need a strong understanding of healthcare administration, managed care processes, and provider relations, often supported by a relevant degree or experience in healthcare management. Familiarity with provider databases, credentialing systems, and health plan software such as CAQH or Facets is typically required. Excellent communication, problem-solving abilities, and attention to detail are vital soft skills for effectively supporting providers and resolving issues. These skills ensure efficient provider onboarding, compliance, and satisfaction, which are crucial for seamless healthcare operations.

What are some common challenges provider specialists face when coordinating between healthcare providers and insurance companies?

Provider Specialists often encounter challenges when ensuring accurate and timely communication between healthcare providers and insurance companies, especially regarding claims processing and credentialing. They may deal with discrepancies in documentation, varying policy requirements, and tight deadlines, which require strong attention to detail and problem-solving skills. Additionally, navigating frequent policy updates and building rapport with both internal teams and external partners are essential parts of the role. Overcoming these challenges helps Provider Specialists contribute to efficient healthcare operations and positive patient experiences.

What is the difference between Provider Specialist vs Medical Assistant?

AspectProvider SpecialistMedical Assistant
Required CredentialsCertification or training in healthcare administration or related fieldsPost-secondary education, certification often preferred
Work EnvironmentHealthcare facilities, clinics, hospitalsClinics, outpatient settings, hospitals
Employer & Industry UsageHealth insurance companies, healthcare providersMedical offices, clinics, hospitals
Common Search & Comparison IntentUnderstanding roles in healthcare administrationPatient care support roles

Provider Specialists focus on healthcare administration, insurance processing, and patient coordination, often working behind the scenes. Medical Assistants primarily support clinical tasks and patient care. While both work in healthcare settings, their roles and required credentials differ significantly.

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Cities with the most Provider Specialist job openings:

What states have the most Provider Specialist jobs?

States with the most job openings for Provider Specialist jobs include:

What are popular job titles related to Provider Specialist jobs?

For Provider Specialist jobs, the most frequently searched job titles are:

Provider Specialist jobs near you
Infographic showing various Provider Specialist job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 76% Full Time, 15% Part Time, and 6% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $69,738 per year, or $33.5 per hour.

IPA, Network Provider Specialist [DALLAS]

Remote

Nutex Health
Health Care and Social Assistance • 1 - 5K employees
Learn more about Nutex Healthexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 hours ago

Job description

IPA, Network Provider Specialist [DALLAS]

TheIPAProvider Network Specialistmanages the physician network by developing and maintaining the assigned IPA/Medical Group. This individual provides service and education to network physicians/providers and achieves company targets by implementing network improvement plans. The representative offers professional work and is responsible for performing activities pertaining to IPA Provider Network Specialist. This job includes traveling to provider offices and working under general supervision. Positions at this level are assigned a broad range of duties in the occupation. The representative uses judgment in selecting appropriate guidelines and applying general policies and procedures.

JOB TYPE: Full-time; On the Road

RESPONSIBILITIES

  • Completes new provider orientation for all applicable product lines.
  • Conducts provider group meetings to review monthly/quarterly data and outcomes.
  • Responsible for meeting minutes and follow-up on 'TO DO' items identified at meetings.
  • Conduct site visits to service providers, resolve issues, educate staff and providers on policies, and collect credentialing information.
  • Conduct site visits to service providers and educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information.
  • Maintains relationships with contracted HMOs to implement amendments to DOFR, delegation, policy, and procedures.
  • Returns all routine calls from providers within 24 hours to establish consistent and robust relationships with provider offices.
  • Provide oversight on inquiries and claims issues and follow up with providers to ensure problems have been resolved.
  • Maintains provider office tools, including provider manual.
  • Supports regional Network Improvement Plan targets by providing utilization reports, ER contingencies, Frequent Flier Reports, and other analytics available to improve /maintain regions.
  • Identifies network gaps and completes contracts for PCP, Specialist, and Ancillary networks with in-depth knowledge of different fee schedules (Medicare/Medical/ASP/AWP).
  • Identifies new cost-saving possibilities through working with various committees, such as UM and Claims.
  • Understands and explains risk contracts (shared risk/entire risk).
  • Strategizes for membership growth and retention.
  • Provide training, mentoring, and guidance to new representatives.
  • Works on special projects as assigned or directed.

QUALIFICATIONS

  • Knowledge of MS Office: Word, Excel, PowerPoint, Access Database.
  • Knowledge of MS Provider relations/customer service strategies.
  • Knowledge of MSO-VL and MMSE programs and services: Authorizations, Claims, Credentialing encounters, RAF, Star Ratings, IS/IR, etc.
  • Knowledge of Network development strategies and Provider Relations experience or similar background.
  • Knowledge of current MSO-VL and MMSE geo-access requirements.
  • Effective and efficient oral and written communication skills.
  • Knowledge of County provider demographics.
  • Skills in negotiating contract language and rate structures.
  • Skills to provide training and technical assistance to contracted providers.
  • Skills to evaluate and assess provider network to determine gaps and services needed.
  • Skills to identify and develop new providers to ensure accessibility.
  • Skills to monitor contract performance through site visits and data analysis.
  • Skills to facilitate contracted provider meetings.
  • Ability to represent the department or division professionally.
  • Ability to establish and maintain effective working relationships with contracted and potential providers.
  • Ability to resolve provider inquiries or requests promptly.

REQUIREMENTS

  • Bachelor's Degree in Marketing or Business Administration
  • Minimum of 2 years experience in Network Management within a managed care environment, health plan, or significant medical group administration.

BENEFITS:

  • 401(k) matching
  • Dental insurance
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

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