Provider Network Optimization & Credentialing Specialist

ATL; Northern (KY); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Paid leave

Medical insurance

Dental insurance

Vision insurance

Short-term disability

Long-term disability

Life insurance

AD&D coverage

Identity theft protection

401(k) with employer match

Tuition reimbursement

Flexible spending account

Health savings account

Job summary

Planned Systems International is seeking a Provider Network Support Specialist to strengthen provider network access, capacity, enrollment, credentialing, compliance, and operational performance for a federal health program. You will analyze provider network data, identify gaps, support enrollment activities, and develop reports for leadership.

The role requires analytical, collaborative, and detail-oriented skills; you will coordinate with clinical, operational, and contractor stakeholders and

Qualifications

• Experience supporting provider network operations, enrollment, credentialing, or related healthcare operations.
• Ability to analyze provider network data, identify gaps, and translate findings into actionable recommendations.
• Experience developing dashboards, reports, or briefing materials for leadership.
• Strong organizational, analytical, problem-solving, and stakeholder coordination skills.
• Ability to manage recurring deliverables and track issues through resolution.
• Ability to handle sensitive healthcare information appropriately.

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 activities.
• Develop and maintain provider capacity analyses, enrollment dashboards, and leadership briefs.
• Review enrollment and credentialing workflows, metrics, and compliance; propose improvements.
• Support provider recruitment, communications, training, and credentialing prioritization.
• Provide consultative support for network-related escalations and provider referrals.
• Support single case agreements and letters of agreement through review processes.
• Conduct quality reviews and audits of provider files and network processes; track corrective actions.
• Develop or update SOPs, process maps, and training materials.
• Participate in program meetings; document decisions and follow up with stakeholders.
• Safeguard member, provider, and program information per privacy and security requirements.

Skills

Data analysis

Dashboard development

Stakeholder coordination

Provider enrollment

Credentialing

Compliance

Process improvement

Reporting

Tools

MS Office

SharePoint

Teams

Job description

Planned Systems International is seeking a Provider Network Support Specialist to strengthen provider network access, capacity, enrollment, credentialing, compliance, and operational performance for a federal health program. You will analyze provider network data, identify gaps, support enrollment activities, and develop reports for leadership.

The role requires analytical, collaborative, and detail-oriented skills; you will coordinate with clinical, operational, and contractor stakeholders and