Senior Provider Relations Representative Jobs in Rosharon, TX

Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Provider Network Manager to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc and we will support you all the way.

Position Overview

The Provider Network Manager (PNM) serves as the primary source of Provider Relations for assigned territories, which may change from time-to-time with targeted providers in an assigned territory. The PNM coordinates with Network Development team to initiate conversations to introduce Verda Healthcare and to develop communications, with the objective to secure participation agreements in accordance with company policies and procedures. The PNM plays a critical role in increasing Verda Healthcare’s brand with providers by identifying, researching, vetting, and developing an assessment of the provider and the overall business landscape, appropriately identifying providers that align with Verda Healthcare. This individual also supports provider network growth strategies and provider network development in all markets.

This position reports to the Senior VP of Operations as part of Verda Healthcare, Inc.

Job Description

• Responsible for provider relations and provider liaison functions
• Conduct initial outreach and telephonic communication which identify provider interest and qualifies them for contracting
• Identify and research resources for developing IPA/Medical group provider leads for new business areas and gaps in provider specialties
• Cultivate a deep understanding of market conditions to determine if practices belong to larger systems that contract as single entities
• Participate in quarterly JOCs and in-servicing providers as necessary to fully serve our members as contractually required. Additionally, assist in provider related issues such as eligibility, member benefits, etc.
• Work with Executive leadership team regarding strategy, program development, provider recruitment, contracting and onboarding initiatives
• Development of an adequate provider network in assigned geographical areas
• Maintaining relationships and all provider relations activities in assigned geographical area until transition to Local Network is completed
• Reporting directly to the Director for status, risks and potential opportunities in area on a regular basis
• Monitor performance, develop, and implement business solutions to address process and quality gaps, and communicate network strategy and planning
• Vendor oversight
• Ability to travel
• Special Projects as assigned

Minimum Qualifications

• Bachelor's degree preferred in Business/Economics, Healthcare Administration, or related field
• Master’s degree or equivalent preferred
• 5+ years minimum experience in managed care contracting (provider relations, provider network development)
• Experience with bundled payment contracting or risk and capitation required
• Proven track record in negotiations and leading meetings, creating agendas, and achieving goals

Professional Competencies

• Microsoft Office and Intermediate computer skills
• Knowledge of Network Management Processes & Services
• Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
• Communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the healthcare field
• Critical listening and thinking skills
• Training/teaching skills
• Strategic management and Time management skills
• Proper phone etiquette
• Decision making/problem solving skills
• Resiliency in a changing environment
• Demonstrated progression of leadership and responsibility
• Ability to work in a fast-paced, start-up culture
• Proven ability to build, develop, and lead strong teams of operators

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Location: Houston, TX

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.