Provider Operations Specialist

Job Description

Are you a detail-oriented person who likes working with people and helping them with their questions and issues? A position as a Provider Operations Specialist may be right for you.

Provider Operations Specialists are responsible for acting as a liaison, working with insurance providers, and helping to resolve issues related to claims. They also help tie so many aspects together, including analyzing data, maintaining contracts, and assisting insurance providers with questions they may have.

Provider Operations Specialists can work in physician’s offices, hospitals, or other health care and wellness facilities.

Typical Duties and Responsibilities

  • Support the provider relations field reps to resolve claims and payment issues
  • Answer incoming telephone inquiries from providers and assist with the problem-resolution of issues
  • Analyze the root causes of operational and health services issues
  • Review and process incoming and outgoing paperwork, including directory updates, provider credentialing applications, contract maintenance forms, and other related forms
  • Provide office, project management, provider recruitment, and data analysis support
  • Assistance with special projects as assigned or directed

Education and Background

This position requires a high school diploma or GED; at least one year of experience in customer service or claims is preferred.

Skills and Proficiencies

  • Adaptable in a fast-paced and changing environment
  • Strong time management skills
  • Excellent verbal and written communication skills
  • Create Excel pivot tables and v-lookups

Compensation

According to Payscale the median annual salary of a Provider Operations Specialist with

1 Year of Experience:

  • Orlando, Florida: $45,000
  • Tampa, Florida: $43,000
  • Jacksonville, Florida: $38,000
  • Miami, Florida: $43,000
  • Atlanta, Georgia: $42,000
  • Chicago, Illinois: $52,000
  • Houston, Texas: $50,000
  • Los Angeles, California: $42,000
  • New York City, New York: $41,000
  • Seattle, Washington: $43,000
  • Overall: $43,000

5 Years of Experience:

  • Orlando, Florida: $59,000
  • Tampa, Florida: $55,000
  • Jacksonville, Florida: $50,000
  • Miami, Florida: $50,000
  • Atlanta, Georgia: $51,000
  • Chicago, Illinois: $65,000
  • Houston, Texas: $62,000
  • Los Angeles, California: $57,000
  • New York City, New York: $65,000
  • Seattle, Washington: $55,000
  • Overall: $56,000

Similar Job Titles

Career Path

The career path for a Provider Operations Specialist starts by first obtaining a high school diploma or GED, as well as having a minimum of one year of experience in customer service or claims. This path often starts as an entry-level position but can have opportunities for ongoing advancement, based on experience and performance.

Position Trends

The health care industry is generally increasing in size year after year. More people are accessing health care services and making insurance claims for those services, which creates a growing need for Provider Operations Specialists.

One reason for this is the aging population in the United States. Older people typically need more health care than young people. As the oversized baby-boom generation ages, the demand for health care services generally increases across the board.

Job Outlook

The job outlook for Provider Operations Specialists is good, with 11 percent job growth projected through 2028, according to the U.S. Bureau of Labor Statistics.

Typical Hours

The typical work hours for a Provider Operations Specialist can be from 9 a.m. to 5 p.m. Monday through Friday in an office setting.

Where You Can Find Jobs

  • 4 Corner Resources
  • Career Builder
  • Glassdoor
  • Indeed
  • LinkedIn
  • Monster 
  • Explore Health Careers

Are You Interested in Becoming a Provider Operations Specialist?

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