Provider Network & Credentialing Specialist

Planned Systems International; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

Planned Systems International seeks a Provider Network Support Specialist to enhance provider access, enrollment, credentialing, and program performance. You will analyze network data to identify gaps, support enrollment activities, and assist with network escalations.

The role requires collaboration with clinical, operational, and contractor stakeholders and a detail‑oriented approach. Strong data reporting skills and MS Office are beneficial in daily work.

Qualifications

• Experience supporting provider network operations or related healthcare functions.
• Ability to analyze operational data and translate findings into actions.
• Experience developing dashboards, reports, or briefing materials.

Responsibilities

• Analyze provider rosters and network data to identify gaps in coverage, access, and credentialing.
• Coordinate with network and clinical stakeholders to validate data and track remediation.
• Develop and maintain provider capacity analyses and enrollment dashboards.
• Review enrollment workflows and compliance concerns; recommend improvements.
• Support provider recruitment, communications, and credentialing prioritization.
• Provide consultative support for network-related escalations and identify qualified providers.
• Assist with single case agreements and letters of agreement through established review processes.
• Conduct quality reviews and audits of provider files; track corrective actions.
• Develop or update SOPs, process maps, training materials, and knowledge resources.
• Participate in program meetings; document decisions and actions; coordinate follow-up.
• Safeguard member, provider, and program information per privacy/security requirements.

Skills

Provider network operations

Provider enrollment

Credentialing

Healthcare operations

Managed care

Data analysis

Tools

MS Office

Teams

SharePoint

Job description

Planned Systems International seeks a Provider Network Support Specialist to enhance provider access, enrollment, credentialing, and program performance. You will analyze network data to identify gaps, support enrollment activities, and assist with network escalations.

The role requires collaboration with clinical, operational, and contractor stakeholders and a detail‑oriented approach. Strong data reporting skills and MS Office are beneficial in daily work.