Virginia Premier Health Plan, Inc.

Have you applied with us before?

Contracting Specialist II

Contracting Specialist II

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4113

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
  • Initiates contracts and the 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 2-4 mid-level provider networks and 2-5 provider specialties
  • Negotiates and process single case agreements
  • Develop and maintain standard operating procedures for the Contracting Specialist team
  • Ensures the accuracy of the IDX, QNXT, Vistar and Selectica databases
  • Works closely with the Provider Services area to assist in recruitment efforts
  • Assist with Provider issues and drives resolution
  • Responsible for learning and maintaining knowledge around Medicaid and Medicare reimbursement methodologies
  • Assist department(s) Analysts with data validation
  • Acts as advisor or consultant to the provider community with respect to contracting and general claims questions.
  • Exercises discretion and works independently to resolve provider issues, questions, and concerns.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

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

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

 

  • Minimum of 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!

Need help finding the right job?

We can recommend jobs specifically for you! Click here to get started.