Provider Network Specialist

Collabrios delivers purpose-built software solutions that unify the entire care journey. By combining deep industry expertise with cutting-edge technology, we empower care providers to streamline operations while delivering exceptional care. From PACE programs to government agencies, our integrated technology infrastructure supports the full spectrum of care delivery.

Job Overview

The Provider Network/Configuration Specialist plays an essential role in maintaining accurate provider and vendor records, linking fee schedules and service codes, and supporting claims configuration to ensure timely and accurate reimbursement. This role requires a strong understanding of provider contracts, attention to detail, and the ability to collaborate across teams to improve operational workflows and claim processing efficiency.

Key Responsibilities 

• Provider & Vendor Records: Create and maintain provider and vendor records in internal systems.
• Fee Schedule Maintenance: Maintain and update fee schedules based on submitted provider contracts.
• Schedule Linking: Link appropriate fee schedules to corresponding provider and vendor records.
• Claims Processing Efficiency: Contribute to auto-adjudication improvements to enhance claims processing.
• Contract Interpretation: Analyze and interpret provider contracts to support accurate reimbursement.
• Issue Resolution: Assist in resolving claims suspended due to provider-related issues.
• Client Reporting: Generate reports for clients as needed.
• Cross-Team Collaboration: Collaborate on fee schedule maintenance and updates across systems and teams.

What You Bring

Required:

• 1–3 years of experience in a health plan, insurance company, or Third Party Administrator (TPA) environment
• Familiarity with Medicare, Medicaid, and PACE programs required
• Completion of training in medical terminology, coding, or claims processing preferred
• Ability to manage multiple tasks and prioritize in a dynamic, fast-paced setting
• Strong analytical and critical thinking skills
• Proficient in Microsoft Office applications and comfortable with digital tools
• Effective relationship-building and communication skills
• Strong organizational skills with the ability to work independently and follow through on tasks
• Clear and professional written and verbal communication skills
• Experience drafting or maintaining departmental policies and procedures is a plus
• Proactive in identifying updates and ensuring documentation reflects current processes

Bonus Points if you have:

• Completion of training in medical terminology, coding, or claims processing
• Experience drafting or maintaining departmental policies and procedures
• Proactive in identifying updates and ensuring documentation reflects current processes

What We Offer
At Collabrios Health, we’re committed to fostering a workplace that supports your well-being, growth, and ability to make a meaningful impact. Here’s what you can expect when you join our team:

• A connected, virtual-first culture with a collaborative, mission-driven team
• Competitive health benefits, including medical, dental, and vision coverage
• 401(k) with company contribution
• Generous paid time off, including 15 PTO days, 2 floating holidays, and 6 sick days
• Flexibility and trust—we empower our team to manage their schedules and work in ways that support their lives
• Opportunities for learning, mentorship, and professional development
• A values-driven environment where diverse perspectives are welcomed and purpose guides our work

We’re committed to building a diverse and inclusive workplace.

Collabrios is an equal opportunity employer. We welcome candidates from all backgrounds, identities, and experiences. If you’re excited about this role but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyway. You may be the right candidate for this or other roles.