Provider Program Lead
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Job Description
Job Title: Provider Program Lead
Reporting to: Manager/Director
Job Summary:
The Provider Program Lead plays a critical role in supporting, developing, and maintaining strong relationships with physicians, providers, and administrators within a healthcare provider network. This position ensures effective communication, handles inquiries related to referrals, eligibility, credentialing, and other policy matters, and escalates or redirects complex issues as needed. The Provider Program Lead tracks and documents all inquiries, ensuring timely resolution, and generates routine reports to identify trends for management.
Additionally, the role involves training healthcare providers and physicians on network operating policies and procedures to uphold high service standards. This individual may provide guidance to less experienced team members and will gain exposure to complex tasks within the job function. The Provider Program Lead operates in a collaborative environment and may occasionally be required to handle complex and varied tasks independently.
Key Responsibilities:
• Develop and maintain service relationships with physicians, providers, and administrators within the provider network.
• Collect and analyze feedback from network stakeholders to survey satisfaction and facilitate ongoing communication.
• Respond to inquiries regarding referrals, eligibility, credentialing, and policy matters, escalating complex questions when necessary.
• Track, document, and follow up on inquiries to ensure timely resolution.
• Create and present regular reports identifying key trends and insights for management.
• Train healthcare providers and physicians on network operating policies and procedures to ensure compliance and service quality.
• Provide mentorship and expertise to less experienced representatives as needed.
• Work on a variety of tasks, occasionally involving more complex situations that require independent judgment.
Qualifications:
• Bachelor's degree in a related field (healthcare administration, business, or a relevant discipline).
• 2-4 years of experience in a healthcare provider network, customer service, or related field.
• Strong communication skills and ability to foster positive relationships with diverse stakeholders.
• Experience with tracking, documenting, and resolving inquiries efficiently.
• Ability to create reports and identify trends for continuous improvement.
• Knowledge of healthcare credentialing, referrals, and eligibility processes is a plus.
• Proven ability to train others and maintain high service standards.
Working Conditions:
• Primarily office-based with occasional local travel to site locations.
• Standard office environment with minimal exposure to noise or extreme temperatures.