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Full-time Provider Network Specialist

at CompServices in Pennsylvania

About Our Company CompServices is always looking for qualified people to administer our current products, research new products and technologies, and provide our customers with the best service.

JOB SUMMARY AND QUALIFICATIONS
This position is responsible for developing the provider network (physician and ancillary) yielding a geographically competitive, broad access, stable network that achieves objectives for access and medical savings for workers’ compensation customers and business partners. Further responsibilities include working with sales and program mangers developing actions to meet market needs and medical savings targets.

The position is also responsible for establishing and maintaining strong business relationships with providers, and ensuring the network composition includes an appropriate distribution provider specialties. Further responsibilities include auditing reports to ensure payments are being made in accordance with negotiated contract terms and educating providers who fail to comply with contractual terms. The position can be located in the Philadelphia, Camp Hill or Pittsburgh, PA office of CompServices, Inc. and reports to the Director of Provider Relations.

PRINCIPAL ACCOUNTABILITIES
- Initiate, follow-up, negotiate, and finalize contracts with providers via mail, telephone and on-site meetings
- Ensure that all recruitment activities are traced in a log or database and occur in accordance with department policies and procedures
- Communicate with internal departments to ensure network needs are being addressed
- Identification of network gaps and payment trends through regular reviews of payment reports or other development tools as needed
- Assure that executed contracts and associated paperwork is complete and processed timely according to department policies and procedures
- Manages provider network by developing and maintaining relationships to drive business results
- Educate providers who do not comply with contract terms, as assigned
- Audit bill or payment reports to ensure payments are being made according to negotiated contracts
- Research network problems and initiate resolution
- Performs other duties as assigned

REQUIREMENTS:
Minimum 5 years experience in worker’s compensation or related field. The incumbent must be highly motivated, a self-starter, independent and assertive. The incumbent should have a background in PPO contracting and negotiating. The incumbent must have strong analytical skills with the ability to explain financial and utilization data. The incumbent must have excellent verbal and written communication skills; working knowledge of MS Office applications; Bachelor’s degree required.

OTHER REQUIREMENTS
- Have valid driver’s license
- Ability to travel throughout Pennsylvania, New Jersey and other states as assigned with little advanced notice. Travel may occasionally require overnight stay.

Equal Employment Opportunity CompServices Inc. is an Equal Opportunity Employer (EOE).

Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status. Agency Disclaimer All resumes submitted directly to a CompServices employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the CompServices Human Resources Department will be deemed the sole property of the CompServices . Please note that no fee will be paid in the event the candidate is hired by the CompServices as a result of the referral or through means other than our established process.

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://independencebluecross.contacthr.com/20740904


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Published on Aug 03, 2011
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