Virginia Premier Health Plan, Inc.

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Contracting Specialist I

Contracting Specialist I

Job Locations 
US-VA-Glen Allen
Job ID 
2017-3974

Job Description

Overview

This position is primarily responsible for assisting the Manager of Contracting and Network Development with all activities relating to provider contracting as well as network development, including but not limited to evaluating and development of the provider network.

 

Responsibilities

  • Involves the identification, recruitment, and the contracting of network providers including:  Primary Care Physicians, Physician Specialists, Ancillary Vendors and other Providers for all lines of business
  • Initiates contracts and credentialing process for community physicians
  • Ensures that network adequacy is met for all assigned provider specialties
  • Monitors changes for contracted providers and works to ensure changes are updated in applicable systems
  • Serves as the contracting point of contact for 1-2 mid-level provider networks and 2-5 provider specialties
  • Ensures the accuracy of the IDX, QNXT, Vistar and Selectica databases
  • Works closely with the Provider Services area to assist in recruitment effortsAssist department(s) Analysts with data validation
  • Assist with Provider issues and drive resolution
  • Responsible for learning and maintaining knowledge around Medicaid and Medicare reimbursement methodologies
  • Process termination for all providers in accordance with regulatory requirements. This includes initiating requests to have paneled members of a terminated provider moved to an active provider.
  • Responsible for Primary Care Physician set up in IDX for Medicaid and MLTSS lines of business.
  • Acts as advisor or consultant to the provider community with respect to contracting and general claims questions.

Qualifications

MINIMUM EDUCATION REQUIREMENTS 

  • Four (4) year college degree from an accredited institution or experience commensurate with position required. 

SPECIAL KNOWLEDGE AND/OR SKILLS 

  • Strong analytical and technical skills
  • Proficient with Microsoft Excel
  • Openly and actively communicates information and takes initiative to communicate extensively
  • Handles difficult situations diplomatically
  • Ability to build strong relationships within and outside the health plan
  • Effective interpersonal skills, collaboration, and listening skills 

WORK BACKGROUND/EXPERIENCE 

  • 1-2 years of experience preferred
  • Experience in an analytical capacity required
  • Previous experience in provider services and contracting helpful

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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