• Network Development Representative

    Job Locations US-VA-Roanoke
    Job ID
    2018-5340
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Network Development Representative provides services in the recruitment, development, and maintenance of a quality provider network. This person develops a strong relationship with Networks and Hospital Systems, physicians, home health and ancillary providers.

    Responsibilities

    • Responsible for developing sufficient network and maintaining relationships to ensure provider satisfaction for all lines of business.
    • Assists with the credentialing and re-credentialing process in accordance with company guidelines.
    • Prompt and efficient response to provider or provider related issues with appropriate and objective documentation of concerns, resolution, monitoring, and re-evaluation.
    • Performs site visits and in-services in accordance with company standards and guidelines.
    • Completes site visit reporting functions and identifies service related issues for resolution.
    • Assure compliance with operational policies and production standards that result in provider network adequacy and member retention.
    • Negotiate financial terms with providers in accordance with the parameters set by Senior Leadership within Virginia Premier.
    • Identify and implement upon approval cost management strategies and process improvement activities.
    • Contribute to preparation, update and production of all marketing and educational materials/manuals.
    • Demonstrate comprehensive understanding of Department of Medical Assistance Services (DMAS) contractual requirements.
    • Perform other duties as required.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelors degree preferred, and in Health Services, Business Administration or other related business field preferred, or 2 years of related experience.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Understanding of Medicaid healthcare insurance markets, Medicare regulations, and managed care concepts.
    • Strong Sales or Account Management background preferred.
    • Proven ability to handle difficult situations diplomatically.
    • Ability to manage multiple projects while meeting deadlines and achieving business goals.
    • Ability to coordinate communication between departments to accurately research and resolve provider or provider related issues.
    • Extensive analytical skills and computer applications.
    • Proven presentation and written communication skills.

    WORK BACKGROUND/EXPERIENCE

    • Proven account management experience.
    • Healthcare or related experience working with providers and hospital organizations preferred.

    PHYSICAL REQUIREMENTS

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

     

     

    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

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