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Provider Services Representative

Provider Services Representative

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Job Description


Provide services in the recruitment and maintenance of a quality provider network in accordance with the corporate plans of Virginia Premier Health Plan, Inc.


  • Follows the direction of the Sr. Manager, Provider Services in the implementation of corporate plans for the development and maintenance of a quality provider network based upon the identified needs of the organization
  • Specifically deals with our Medicaid and Medicare network and acts as the Subject Matter Expert for Medicare and Medicaid issues for the department
  • Participates in the active recruitment and retention of Plan providers for both Medicaid and Medicare
  • Assists in the submission of completed new provider applications to the Contracting Staff for Credentials processing in accordance with company policies and procedures
  • Schedules and reports activities associated with physician and/or office staff training or retraining in Virginia Premier Health Plan utilization, quality assurance, and business policies and procedures
  • Chairs Provider Education Meetings, Stakeholder Meetings, Town Halls and any other external provider educational events.
  • Assists in engendering provider compliance with the terms of the Virginia Premier Health Plan provider agreement as necessary
  • Provides prompt and efficient response to provider or provider-related issues with appropriate, objective documentation of concerns, recommendations of resolution, monitoring and re-evaluation.
  • Participates in the elaboration, maintenance and distribution of accurate provider information, lists, and reports within and external to Virginia Premier Health Plan.
  • Complies with Plan personnel policies and procedures



  •  Bachelors Degree in Health Services, Business Administration or other related business fields


  • Analytical skills – proficient using Microsoft Office including Microsoft Excel
  • Openly and actively communicates information and takes initiative to communicate extensively 
  • Ability to handle difficult situations diplomatically
  • Effective interpersonal skills, collaboration, and listening skills
  • Strong strategic and business acument and well grounded in helathcare delivery systems
  • Negotiation skills
  • Must be comfortable with speaking and interacting with the public


  • Previous eperience in provider servies and contracting helpful
  • Medicare/Medicaid experience/ knowledge preferred 


  • 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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