**JOB PURPOSE:** The purpose of the Provider Relations Development Specialist role for PruittHealth Premier to support the plans (I-SNP and D-SNP) with contract outreach and supporting maintenance of network adequacy. Their role is to identify potential contracts needed in existing and developing service areas and help ensure timely outreach to assist with maintaining an adequate and supportive network. In addition, they would assist with outreach through in-person or online meetings to foster key network relationships. **KEY RESPONSIBILITIES:** 1. Identifies plan network gaps utilizing the plan dashboard and other available resources. 2. Identifies targeted solutions to resolve network gaps using available tools and responsible for determining if solution fills the identified gap. 3. Conducts outreach by phone or email to providers to provide plan overview and request to contract 4. Responsible for sending specified plan contract and credentialing documents along with W-9 and EFT form to provider for contracting with the plan. 5. Answer provider questions regarding the contract language and reviewing any revisions to the contracts for approval. 6. Responsible for evaluating impact of redlines and working with leadership to send for approval to appropriate operational leadership for significant changes. 7. Responsible for full review of completed contracts and credentialing documents prior to sending to the Plan Network Support team. 8. Updating tracking tools for received contracts and tracking through the credentialing process for completion 9. Checking credentialing system for providers who have credentialing issues and reaching out to providers for expired or other needed information in order to complete credentialing 10. Manages emails received from Provider Network team for requests to join the network and reviews to determine if the provider is needed for the plan. Determine if provider request is valid and necessary, reach out to the provider with the contracting /credentialing documents and adds that provider to network contracting tracking. 11. Responsible for provider requests; performing outreach when a member, facility, or plan staff member requests a provider be added to the network 12. Responsible for PCP/NFist contracting and credentialing once notified of a new PCP. 13. Responsible for expediting plan NP contracting and credentialing 14. Responsible for sending credentialing needing approval to plan Medical Director for review and approval 15. Meeting bi-weekly with Provider Network Management representative to review gaps and solutions as well as any other contracting or credentialing issues 16. Reviewing credentialing outreach report and identifying priority providers to send to 3rd party Client Management Team for information outreach to complete credentialing 17. Finding and reviewing standing contracts for providers, plan leadership and the Network Team. 18. Responsible for facilitating reviews of contract amendments and editing contracts for providers upon request. 19. Provide executed contracts to providers and offer education on setting up billing/claims submission. 20. Follow up to ensure contracted providers are loaded and showing as in network and escalate any issues. 21. Identify providers that are contracted with but not credentialed and outreach to get credentialing documents completed. 22. Sending provider updates of ownership to network management and following up to ensure they are loaded correctly. 23. Monitoring providers that need to be recredentialed including the Delegated Contracting providers and ensuring provider network management facilitates that timely. **KNOWLEDGE, SKILLS, ABILITIES:** • Strong technological skills to work from multiple platforms for network management including Microsoft Office Suite. • Comfortable/patient in communicating via web-based video platforms. • Assertive self-starter who can influence others. • Strong written and verbal communication skills with abilities to deliver presentations in an impactful manner. • Proven ability to work independently and productively as well as with a team. • Willingness and ability to travel to in-person contract discussion meetings as needed. • Knowledge of credentialing requirements for health plans • Knowledge of CMS required contracting language for Medicare Advantage Plan agreements • Demonstrate compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code of Conduct. • Exceptional organizational skills; strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages. • Have suitable home workspace allowing for productive office environment. • Understands the PruittHealth Premier Plan benefits, provider manual, evidence of coverage, provider billing requirements and other procedures for network management and articulate them effectively to providers and teammates. • Complete annual Medicare Fraud, Waste and Abuse Training and Model of Care Training **MINIMUM EDUCATION REQUIRED:** Bachelor’s degree or 2 years related experience. **MINIMUM EXPERIENCE REQUIRED:** Good communication skills and organizational skills needed Ability to professionally present plan and plan contracts **ADDITIONAL QUALIFICATIONS:** (Preferred qualifications) • 2 years health plan network support experience preferred **Family Makes Us Stronger.** Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference. We are eager to connect with you! **_Apply Now_** to get started at PruittHealth! _As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status._