Job Summary

The Provider Engagement Specialist supports the Provider Engagement team in driving value-based care initiatives, strengthening provider relationships, and improving operational performance across home health, private duty nursing, and shift care programs. This role functions as a subject matter expert on Electronic Visit Verification (EVV), program workflows, and provider compliance requirements. The Specialist delivers high-quality service support, maintains data accuracy, contributes to education materials, and provides insight to help develop strategic provider engagement efforts.

Job Duties

Provider Engagement & Support

• Support the Provider Engagement team with value‑based program discussions, provider outreach, and data‑driven analysis.
• Assist the Provider Engagement Liaison with provider education and compliance efforts specific to Home Health specialties.
• Serve as a subject matter expert on policies, procedures, workflows, and training needs related to home health, private duty nursing, and shift care.

Provider Inquiry & Issue Resolution

• Deliver responsive service support across the provider network.
• Effectively resolve provider inquiries related to claim denials tied to Electronic Visit Verification (EVV) requirements.
• Track, log, and monitor provider inquiries to identify trends, gaps, and opportunities for improvement.

Data Management & Quality Control

• Coordinate EVV data collection, perform ongoing maintenance, and conduct routine quality control audits.
• Interpret operational and program reports to prioritize assignments and escalate issues as appropriate.
• Maintain and update desk procedures for EVV monitoring.

Program Development & Education

• Support the Provider Engagement team in the development of provider engagement strategies.
• Contribute to the creation of provider education materials, resources, and compliance documentation.
• Identify workflow opportunities and recommend enhancements based on data insights.

The provider engagement team will work with our external provider partners to provide exceptional service and issue resolution. The role is responsible for providing updates, resources and education, as well as tracking. Collaborates with internal departments to solve provider inquiries and ensure continued provider satisfaction.

• Supports the Provider Engagement team with value based program discussions and analysis.
• Tracks and logs inquiries and identify trends.
• Acts as a subject matter expert on policies, procedures, workflows, and training needs.
• Provides service related functions and resolves service inquiries.
• Supports the Provider Engagement team in strategy development.
• Contributes to the development of provider education materials and resources.
• Interprets reports and prioritizes assignments.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Position Details

Qualifications & Experience

• 2-4 years of experience working in healthcare administration, provider relations, managed care, home health operations, or a related field.
• Knowledge of Medicare and Medicaid home health regulations, policies, and reimbursement requirements.
• Working knowledge of Pennsylvania (PA) Medicaid requirements specific to:
  • Private Duty Nursing (PDN) and Shift Care EVV requirements
  • Related authorization, documentation, and billing rules
• Experience with Electronic Visit Verification (EVV) platforms, tracking, compliance, and denial resolution.
• Ability to interpret and analyze healthcare data, reports, and provider activity trends.
• Strong communication and relationship-building skills with providers and internal partners.
• High level of organizational skills with the ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office (Excel, Outlook, Word, Teams) and ability to learn new systems quickly.
• Strong problem-solving abilities and attention to detail.

Education

High School Diploma or Equivalent (GED)- (Required), Bachelor's Degree- (Preferred)

Experience

Minimum of 3 years-Relevant experience* (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.

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