Network Development Representative

Position Summary:

The Network Development Representative is responsible for creating and maintaining the provider network and provider relationships for ApexHealth within the assigned territory.

Essential Function:

  • Provide ongoing external servicing of providers to ensure that a positive relationship is maintained between ApexHealth and its providers
  • Assist in the provider contract negotiation process (as necessary)
  • Assist in the collection of signed contracts, applications and other necessary credentialing documents
  • Present Orientation Program for all providers who complete the credentialing process
  • Resolve provider complaints and grievances process(es) and ensure that concerns are addressed in a timely and thorough manner
  • Assist in potential service area expansion consistent with the ApexHealth plan for service area growth and expansion
  • Perform other duties as assigned

Job Requirements:

Education:

  • Bachelor’s Degree (or an equivalent) is preferred

Experience:

  • Previous experience in a provider and/or network services role is preferred

Knowledge:

  • Knowledge of provider contracts, including but not limited to, Primary Car, Specialty Care, Ancillary Care, Hospital, and Organizational Master
  • Knowledge of Medicare Advantage and managed care strategies, reimbursement methodologies, and rates
  • Knowledge of geographic areas in which ApexHealth is licensed to operate, including, types of providers in area, relationships between providers (PO, PHO, independent), key providers/decision makers, enrollee demographics, and other competing health plans

Skills:

  • Strong problem solving and process improvement skills
  • Strong project management skills
  • Strong communication/public-speaking skills
  • Strong strategic planning skills

Abilities:

  • Ability to travel within assigned territory
  • Ability to be flexible in a rapidly changing job environment
  • Ability to speak effectively to and with small or large groups
  • Ability to manage team members to achieve goals and exceed expectations
  • Ability to work independently and to manage multiple priorities

Travel:

  • Must reside within the assigned service areas (North Carolina and South Carolina)
  • Must be willing to travel within service area visiting Provider locations
  • No overnight travel required

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