Provider Engagement Specialist, Plan; Pennsylvania resident

Position: Provider Engagement Specialist, Geisinger Health Plan (Pennsylvania resident)
Location:
Work from home (Pennsylvania)

Shift:
Days (United States of America)

Scheduled Weekly

Hours:


40

Worker Type:
Regular

Exemption Status:
No

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):

Skills:
Communication, Computer Literacy, Customer Service, Group Presentations, Health Insurance

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…