Provider Engagement Specialist, Health Plan; Pennsylvania resident

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.

• 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.

• 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.

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

• 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.

• 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.

High School Diploma or Equivalent (GED) – (Required);
Bachelor’s Degree – (Preferred)

Minimum of 3 years of relevant experience – (Required)

Everything we do is about caring for our patients, our members, our students, our Geisinger family, and our communities. We strive for kindness, excellence, learning, innovation, and safety. We offer comprehensive benefits and foster a collaborative, inclusive workplace.

We are proud to be an affirmative action, equal opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.