Credentialing and Contracting Medical Provider Network Specialist
Location
United States
Posted
3 days ago
Salary
$17 - $19 / hour
Seniority
Mid Level
Job Description
Credentialing and Contracting Medical Provider Network Specialist
Tristar Insurance
Role Description The Credentialing and Contracting Specialist is responsible for preparing and maintaining contracts and the contracts database system. Maintain active status for all providers by successfully completing initial and subsequent credentialing packages as required by state regulations, guidelines and policies. Essential Duties and Responsibilities - Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with regulations, guidelines, policies, and standards. Monitors Applications and follows-up as needed. - Conducts primary source verification, collects and validates documents (state license, DEA Certificates, malpractice coverage, etc.) to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards to ensure timely renewal. Maintains provider contract files. - Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Director for sound decision making in accordance with credentialing policies and procedures, state regulations. - Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate. - Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures. - Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines. - Participates in the development and implementation of process improvements for the credentialing process. - Communicates clearly with providers, their liaisons, and staff as needed to provide timely responses upon request on day-to-day credentialing, provider, staff and client issues as they arise. - Assists in helping find available physician(s) when unavailable within the Network. - Maintains professional growth and development through professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry. - Performs miscellaneous job-related duties as assigned. Qualifications - Ability to communicate effectively both orally and in writing. - Customer service skills. - Ability to respond to emails timely and effectively. - Information research skills. - Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation. - Ability to use independent judgment and to manage and impart confidential information. - Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications. - Ability to make administrative/procedural decisions and judgments. - Demonstrated advanced working knowledge of Microsoft Word and Excel. - Ability to learn new applications to function effectively in a remote work environment. - Skill in establishing priorities with independent coordination of day-to-day aspects. - Skills in computerized spreadsheeting and database management. - Ability to organize and prioritize work and manage multiple priorities. Requirements - High school diploma or equivalent required. - Computer skills required with knowledge in utilizing Outlook, Microsoft Word, Excel and other databases. Benefits - Medical, Dental, Vision Insurance - Life & Disability Insurance - Paid time off - Paid holidays - 401(k) plan - Referral bonus
Related Guides
Related Categories
Related Job Pages
More Network Engineer Jobs
• Lead design and implementation of ZTNA solutions (Zscaler ZPA/ZIA, ZVPN) to replace legacy VPN technologies • On call required rotation • Define and deliver modern Zero Trust architecture patterns, including application-level segmentation and identity-based access • Drive legacy VPN decommissioning and migration to ZTNA platforms • Develop and execute engineering roadmaps aligned to enterprise remote access strategy • Partner with security, infrastructure, and business units to ensure coordinated rollout and adoption • Document architecture, operational models, and implementation standards • Evaluate emerging ZTNA and secure access technologies and provide data-driven recommendations • Lead pilots and phased deployments, including testing, validation, and performance benchmarking • Act as a Tier-3 escalation lead for complex remote access and connectivity issues • Ensure high availability and resilience of remote access infrastructure in a 24x7 global environment • Assess and mitigate risks related to latency, scale, and user experience during migrations
• Responsible for designing, implementing, and supporting large-scale data center and backbone network infrastructure, with a focus on switching, routing, and data center design. • Design, implement, and support data center and backbone network infrastructure, including spine-and-leaf topologies, advanced routing protocols (BGP, OSPF, EVPN, VXLAN, MPLS, EIGRP), and high-availability architectures. • Architect and document LAN/WAN connectivity, inter–data center peering, cross- connects, and backbone integration to support scalable cloud and enterprise environments. • Create data center layouts and infrastructure designs using AutoCAD. • Maintain detailed drawings, rack elevations, logical/physical diagrams, and cable matrices using AutoCAD and Visio. • Manage white space design, including rack layouts, structured cabling, hot/cold aisle containment, branch circuit distribution, power pathways, and airflow optimization. • Conduct capacity planning, traffic engineering, and scalability analysis to optimize network performance and support future growth. • Deploy, configure, and troubleshoot switches, routers, and firewalls across multi-vendor platforms (Cisco, Juniper, Arista, Palo Alto, Aruba). • Collaborate with colocation providers, facilities teams, and internal stakeholders to define technical requirements and deliver compliant infrastructure designs. • Research and evaluate emerging networking, optical transport, and structured cabling technologies, contributing to global data center and network infrastructure standards. • Coordinate and evaluate vendor RFI/RFP/RFQ submissions for networking hardware, cabling solutions, and infrastructure services. • Provide technical leadership and mentorship to junior engineers, ensuring best practices in network design, deployment, and documentation. • Travel to data center and POP sites to perform network assessments, audits, migrations, and engineering validation for new builds and expansions. • Lead the review, development, and maintenance of comprehensive data center and network documentation. • Work with stakeholders and cross- functional teams on projects and initiatives to develop low-level design documents and automation workflows to improve deployment efficiency. • Perform other related duties as required.
Role Description We're looking for a Senior Network Engineer to own and evolve our enterprise network across multi-site and cloud environments. You'll be a key technical voice shaping infrastructure strategy, driving security posture through zero-trust principles, and ensuring high availability for business-critical systems — all while working remotely on a collaborative, senior-level team. Key Responsibilities - Design & Architecture - Architect scalable, resilient network solutions including routing/switching, SD-WAN, firewalls, VPN, QoS, and zero-trust segmentation. - Define requirements, evaluate technologies, and lead infrastructure changes from design through implementation. - Develop and maintain business continuity and disaster recovery plans for all network components. - Operations & Maintenance - Perform proactive maintenance — patching, upgrades, tuning, and health monitoring across the networking estate. - Manage vulnerability findings and vendor security advisories for network equipment and systems. - Maintain accurate network documentation, configuration baselines, and topology diagrams. - Own and resolve network-related incidents and service requests, driving issues to resolution. - Collaboration & Strategy - Partner with security, infrastructure, and application teams to support firm-wide initiatives. - Evaluate emerging technologies and translate their impact into actionable recommendations. - Serve as a technical mentor and backup resource across the Network Engineering team. - Communicate clearly with technical and non-technical stakeholders at all levels. Qualifications - 10+ years of hands-on network engineering experience across multi-site enterprise environments. - Bachelor's degree in Computer Science, Information Technology, or a related field — or equivalent professional experience. - Palo Alto Firewalls - Production deployment, policy management, and troubleshooting of Palo Alto NGFW (Panorama experience a strong plus). - Cisco ACI - Hands-on experience with Nexus 9300/9000 series in ACI mode — fabric design, EPG/contract configuration, and troubleshooting. - Proven ability to architect, implement, and troubleshoot complex, multi-vendor network infrastructure. - Strong documentation habits — you leave networks better documented than you found them. - Ability to translate ambiguous business requirements into clear, implementable technical designs. - Excellent communication skills — comfortable presenting to both engineers and executives. - Strong project management instincts with the ability to juggle multiple workstreams independently. - A collaborative, team-first mentality balanced with the ability to drive work autonomously. Requirements - Deep expertise in enterprise routing protocols (OSPF, BGP) and switching (VLANs, port channels, spanning tree, QoS) across multi-site environments. - Cisco certification at the professional or expert level (CCNP, CCDP, or CCIE) strongly preferred. - Experience in professional services, financial services, or legal industry environments. - Familiarity with network automation tooling (Ansible, Python/Netmiko, Terraform for network infra). - Experience with public cloud networking (AWS, Azure) and hybrid connectivity patterns. - Exposure to Panorama for centralized Palo Alto management at scale. Benefits - Outstanding benefits package, including 401k match and generous PTO plan. - Ample opportunities for professional development and advancement. - Access to corporate discount plans and other benefits.
Network Engineer
UnitedHealth GroupUnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. - Implement, administer, and troubleshoot network infrastructure devices, including wireless access points, firewall, routers, switches, load balancers. - Knowledge of application transport and network infrastructure protocols. - Assist in research and evaluations of new products and process improvements within IT. - Assist in the implementation and enforcement of security procedures to ensure the Company’s data is secure and accessed by only those that need access to it. - Maintain documentation in relation to network configuration, mapping, processes, and service records. - Assist in the evaluation of network performance, identifying bottlenecks, and finding ways of improvement, to ensure long-term efficiency of the network. - Assist in developing test plans that include functionality, system integrity, test matrixes, strategy, and definition of test methodologies. - Create test platforms, including evaluation of test equipment, and testing of proposed network equipment, network protocols and new production applications. - Assist in designing, testing and deploying network and security architectures, including LAN-to-LAN, LAN-to-WAN, and WAN-to-WAN. - Work closely with IT staff to identify opportunities for automation within network operations. - Ensure compliance with security policies and practices in network automation scripts and tools. - Assist in the architectural design of existing and new infrastructure implementations. - Participate in problem management and root cause analysis. - Follow all escalation procedures according to service level agreement. - Provide an accurate record of work in request / incident management tracking tools. - Assist in the coordination and troubleshooting of system problems; document system events to ensure continuous functioning. Recommend course of action and implementations as approved. - Utilize Change Control process when scheduling maintenance for Optum Serve’s environments. - Maintain system inventory through centralized management database and tools. - Respond to and resolve technology escalation requests. - Assess risks when making changes to managed systems within the IT environments. - Participate in 24x7 On-Call rotation. - All other tasks as assigned. Qualifications - HS Diploma required. - 4+ years of hands-on experience working in a network environment/network administration with 24/7 mission critical systems. - 4 years’ experience with strong troubleshooting and analytical skills along with good interpersonal communication skills and the ability to work independently to meet required deadlines. - Ability to work off-hours as job tasks required. - United States citizenship is required for this position. - Must be able to obtain and maintain a suitability or determination of eligibility for a Confidential/Secret or Top-Secret security clearance. Requirements - Strong interpersonal skills include the ability to present, persuade and provide professional presentation materials to both large and small groups. - Excellent teamwork skills and demonstrated ability to work independently. - Organizational skills, project, and time management, and follow-through and attention to detail. - An equivalent combination of education, experience and/or applicable military experience will be considered. - Experience with LAN, WAN, Cisco, NetScaler, Palo Alto, IPsec VPN, Forescout, and Algosec. - Experience with change management processes, documentation procedures, and the ITIL framework. - CCNP. - Experience with network design & optimization, business technology infrastructure strategic planning, projects management and policy development. - Working experience with Azure. - Working experience and knowledge of Infrastructure as Code. - ITIL or other ITSM framework certification. - DOD/VA/Military Experience. - DOD/VA/Military Clearances. - National Career Readiness Certificate. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

