What Does a Provider Operations
Specialist Do?
A provider operations specialist is responsible for managing the operational processes that support healthcare providers within a network. They ensure that physicians, hospitals, and clinics are properly credentialed, onboarded, and supported in compliance with regulatory and organizational requirements. Provider operations specialists play a critical role in maintaining the accuracy of provider records, contracts, and enrollment data to ensure seamless delivery of care.
In addition to credentialing and onboarding, a provider operations specialist acts as a liaison between providers and internal departments, resolving operational issues, analyzing workflows, and supporting efficiency initiatives. They ensure that provider data is accurate and up to date, coordinate with billing and compliance teams, and monitor adherence to contractual and quality standards. Their role is essential to optimizing provider relationships and ensuring high-quality patient care within healthcare organizations.
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Provider Operations Specialist Core Responsibilities
- Manage provider onboarding, credentialing, and enrollment processes
- Maintain accurate provider data in systems and databases
- Ensure compliance with regulatory, payer, and organizational requirements
- Support contract administration and provider agreements
- Act as a liaison between providers and internal departments to resolve issues
- Track provider performance metrics and support quality initiatives
- Generate reports and provide data analysis for leadership
- Assist with audits and compliance reviews as needed
Required Skills and Qualifications
Hard skills
- Knowledge of healthcare operations, credentialing, and compliance standards
- Proficiency with provider data management systems and Microsoft Office
- Ability to analyze data and prepare operational reports
Soft skills
- Strong communication and relationship-building abilities
- Attention to detail and organizational skills
- Problem-solving and issue resolution abilities
- Ability to manage multiple priorities under deadlines
Education
- Bachelor’s degree in healthcare administration, business, or related field required
Certifications
- Certified Provider Credentialing Specialist (CPCS) recommended
- Certified Professional in Healthcare Quality (CPHQ) recommended
Preferred Qualifications
- 2–4 years of experience in provider operations, credentialing, or healthcare administration
- Experience working with insurance providers, hospitals, or health systems
- Familiarity with regulatory requirements such as NCQA, CMS, or state-level standards
National Average Salary
Provider operations specialist salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Provider Operations Specialist is:
$63,956
Sample Job Description Templates for Provider Operations Specialists
Entry-Level Provider Operations Specialist
Position Overview
We are seeking an entry-level provider operations specialist to support onboarding, credentialing, and provider data management activities. This role is ideal for recent graduates or early-career professionals looking to gain experience in healthcare operations.
Responsibilities
- Assist with provider credentialing, enrollment, and onboarding tasks
- Enter and update provider data in systems with accuracy
- Prepare basic reports and documentation for audits or compliance reviews
- Support communication between providers and internal departments
- Monitor inboxes and respond to provider inquiries in a timely manner
- Maintain organized records of provider contracts and documentation
Requirements
Hard skills
- Familiarity with healthcare administration processes
- Proficiency with Microsoft Office Suite and data entry tools
- Basic knowledge of credentialing or compliance standards
Soft skills
- Attention to detail and accuracy in data management
- Good written and verbal communication skills
- Strong organizational and multitasking abilities
Education
- Bachelor’s degree in healthcare administration, business, or related field required
Preferred Qualifications
- Internship or administrative experience in healthcare operations
- Exposure to provider credentialing or insurance processes
Junior Provider Operations Specialist
Position Overview
We are hiring a junior provider operations specialist to assist with credentialing, contract administration, and provider data management. This role requires some experience in healthcare operations and the ability to manage smaller tasks with minimal supervision.
Responsibilities
- Process credentialing and re-credentialing requests in compliance with standards
- Review provider contracts and support document preparation
- Update and validate provider data in databases and portals
- Track provider information to ensure compliance with regulatory requirements
- Communicate with providers to resolve minor operational issues
- Assist with reporting on provider performance and enrollment status
Requirements
Hard skills
- Knowledge of credentialing, enrollment, and provider data systems
- Ability to interpret provider contracts and documentation
- Proficiency in Excel and reporting tools
Soft skills
- Strong communication and problem-solving skills
- Ability to prioritize tasks and meet deadlines
- Detail-oriented with a focus on accuracy
Education
- Bachelor’s degree in healthcare administration, business, or related field required
Preferred Qualifications
- 1–2 years of experience in provider operations, credentialing, or healthcare administration
- CPCS certification in progress or recommended
Mid-Level Provider Operations Specialist
Position Overview
We are seeking a mid-level provider operations specialist to manage credentialing, data accuracy, and provider issue resolution independently. This role requires a solid understanding of provider operations and the ability to support process improvements.
Responsibilities
- Manage provider enrollment, credentialing, and re-credentialing activities
- Ensure accuracy of provider data across multiple systems
- Monitor compliance with payer, regulatory, and organizational standards
- Analyze workflows and recommend efficiency improvements
- Act as a point of contact for providers and resolve operational issues
- Generate detailed reports for leadership on provider operations metrics
Requirements
Hard skills
- Strong knowledge of healthcare operations and compliance requirements
- Proficiency with provider management systems and reporting tools
- Ability to analyze data and identify trends
Soft skills
- Strong organizational and time management skills
- Effective collaboration with providers and cross-functional teams
- Clear written and verbal communication skills
Education
- Bachelor’s degree in healthcare administration, business, or related field required
Preferred Qualifications
- 3–5 years of provider operations or credentialing experience
- CPCS or CPHQ certification recommended
Senior Provider Operations Specialist
Position Overview
We are hiring a senior provider operations specialist to oversee complex provider operations tasks, ensure compliance with regulations, and mentor junior staff. This role requires advanced expertise in provider credentialing, contracts, and data management.
Responsibilities
- Lead provider credentialing, enrollment, and re-credentialing processes
- Supervise provider data audits and compliance reviews
- Mentor and train junior operations specialists
- Serve as escalation point for complex provider issues
- Collaborate with leadership to refine provider operations strategies
- Present reports and performance insights to senior management
Requirements
Hard skills
- Advanced knowledge of provider credentialing and compliance frameworks
- Proficiency in database management and analytics tools
- Strong understanding of payer and regulatory requirements
Soft skills
- Leadership and mentoring abilities
- Strong decision-making and problem-solving skills
- Excellent communication and negotiation skills
Education
- Bachelor’s degree required; master’s degree in healthcare administration or related field preferred
Preferred Qualifications
- 5–7 years of provider operations or healthcare administration experience
- CPCS certification strongly recommended
Lead Provider Operations Specialist
Position Overview
We are seeking a lead provider operations specialist to provide technical direction and oversight for provider operations teams. This role requires advanced knowledge of healthcare operations and the ability to ensure compliance and efficiency across processes.
Responsibilities
- Oversee provider data management, credentialing, and contract administration processes
- Review and approve compliance reports and provider documentation
- Lead audits and support regulatory inspections
- Train, mentor, and guide junior and mid-level specialists
- Collaborate with managers to improve workflows and system processes
- Serve as subject matter expert on provider operations policies and standards
Requirements
Hard skills
- Mastery of provider operations, compliance, and credentialing requirements
- Advanced proficiency in provider management and analytics systems
- Experience with regulatory reporting and audit preparation
Soft skills
- Leadership and coaching skills
- Strong communication and stakeholder management abilities
- Strategic thinking and organizational planning
Education
- Bachelor’s degree required; master’s degree preferred
Preferred Qualifications
- 7–10 years of provider operations experience with leadership responsibilities
- CPCS or CPHQ certification strongly preferred
Provider Operations Manager
Position Overview
We are hiring a provider operations manager to lead the provider operations department, oversee staff, and ensure organizational compliance. This role requires leadership, strategic planning, and accountability for provider operations success.
Responsibilities
- Manage provider operations teams across multiple functions
- Develop policies, procedures, and performance standards for operations
- Oversee credentialing, enrollment, and provider data management
- Collaborate with executives to align provider operations with organizational strategy
- Monitor and report on KPIs and compliance outcomes
- Allocate resources, manage budgets, and optimize efficiency
- Support leadership development and staff training within the team
Requirements
Hard skills
- Expertise in healthcare operations, credentialing, and compliance standards
- Strong knowledge of provider data management systems
- Financial and budget management experience
Soft skills
- Executive-level leadership and communication abilities
- Strong problem-solving and decision-making skills
- Ability to build and develop high-performing teams
Education
- Bachelor’s degree required; master’s degree in healthcare administration, business, or related field strongly preferred
Preferred Qualifications
- 10+ years of provider operations experience, with at least 3 in management
- CPCS, CPHQ, or equivalent advanced certification is highly desirable