Provider Network Specialist

Job Description

Job Description

Hybrid-Sunrise, Florida

Position Summary: The Provider Network Specialist is responsible for contracting, servicing, and supporting the Applied Behavior Analysis (ABA) provider network for the Medicaid Managed Medical Assistance (MMA) program. This role serves as the primary point of contact for ABA providers and is accountable for both network development and ongoing operational support. While the current focus is on ABA, the role may evolve to support additional Behavioral Health specialties as the network grows.

Essential Duties and Responsibilities:

1. ABA Network Contracting & Development
   • Lead provider outreach and execute contracts with ABA groups and independent practitioners.
   • Ensure contracts comply with Medicaid regulations, reimbursement policies, and internal standards.
   • Maintain records of contract status, rates, and operational milestones.
2. Provider Servicing & Support
   • Act as the main point of contact for ABA provider inquiries related to contracting, credentialing, claims, and authorizations.
   • Support onboarding and training for new providers to ensure operational readiness.
   • Track and resolve provider issues in collaboration with internal teams such as Claims, UM, Credentialing, Quality and Compliance.
   • Monitor provider performance and contractual compliance.
3. Network Adequacy & Data Accuracy
   • Collaborate with the Provider Data and Credentialing teams to support accurate and timely provider record updates.
   • Monitor ABA network adequacy and help address service area or specialty gaps in alignment with AHCA standards.
   • Support audits, readiness reviews, and regulatory documentation related to the ABA network.
4. Future Expansion to Behavioral Health
   • Assist in preparing for broader Behavioral Health network servicing if future needs expand beyond ABA .
   • Help standardize provider management processes across Behavioral Health specialties as needed.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Behavioral Health, Social Work, Business, or a related field.
• 2 years of experience in provider contracting, network support, or provider relations.
• Familiarity with Florida Medicaid MMA requirements and Behavioral Health services, especially ABA.
• Excellent communication, organization, and relationship-management skills.
• Proficiency in Microsoft Office and provider network systems.
• Bilingual (Spanish or Creole) preferred.

Skills and Abilities:

• Strong interpersonal and relationship-building abilities
• Contract negotiation and provider onboarding
• Detail-oriented with excellent organizational skills
• Ability to manage multiple priorities and deadlines
• Data entry, documentation, and tracking accuracy
• Critical thinking and problem-solving
• Understanding of Medicaid/MMA regulations
• Ability to collaborate cross-functionally with internal teams
• Professional written and verbal communication
• Proficiency in Excel, Word, and provider data platforms

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.