# of Positions :
Minimum Education Level :
Experience Required :
Full Time Regular
First Shift (Day)
Hours per week:
Represents MVP Healthcare in a professional and ethical manner while enhancing the corporate image and mission to new and existing provider customers. Provides superior services to network providers remotely in the provider’s offices. Provides orientation and education to new and existing physicians and office staff and coordinates resolution of issues. Maintains effective, positive, cooperative relationships with network providers with a goal of increasing their overall satisfaction with MVP. Participates in recruitment of new providers to expand MVP’s provider base established and newly licensed/expansion areas through: Network analysis to ensure that the MVP network meets all of the NYS and other requirements regarding network adequacy. Identification and solicitation of providers to include in network. Contract negotiation, including contract language and rates and presenting nonstandard items to the C-series meeting for approval. Conducts sites visits as required by credentialing. Meets with providers, facilities, and/or their staff to market, orient, and educate regarding MVP policy, protocols, and initiatives. Knows, interprets, and follows guidelines of MVP policies and rules. Maintains and communicates in-depth and up-to-date knowledge of regional competition. Functions as contact to providers with unresolved issues and follows through to resolution, maintaining detailed documentation. Manages and presents both small and large group presentations independently, including preparing the logistics, agendas, written presentations, content, and evaluations. Actively participates in annual provider seminars, including preparing the logistics, agendas, verbal presentation, content and evaluations. Develops relationships with internal staff including but not limited to regional marketing, claims/operations, member/provider services, health management, and Medicare risk adjustment team and support teams through educating providers on initiatives. Support shared risk initiatives as the liaison to physicians and their staff on risk reporting that includes payment reform, quality metrics, efficiencies, and delivery of practice score cards. Performs other duties as assigned.
BA/BS Degree in Health, Marketing, or Business Administration preferred or Associates Degree with equivalent combination of experience considered.
2-3 years’ experience in a health care field with demonstrated provider recruitment and/or service track record preferred.
• Familiarity with office practice procedures, pre authorization and referral issues, fee policy and billing processes, the provider grievance and appeal process, physician performance reporting.
• Excellent communication and interpersonal skills, including the ability to negotiate, interact face-to-face and over the telephone with customers.
• Demonstrated strong presentation and facilitation skills.
• Ability to effectively handle difficult interpersonal situations.
• Demonstrated strong written skills, including the ability to create letters and other communications to providers.
• Valid NYS driver’s license and access to reliable vehicle, willing to travel extensively throughout MVP’s service areas, with overnights as required.
• Strong analytical problem solving and strategic business planning skills.
• Strong computer skills (Word, Excel and PowerPoint or comparable software) required. Proficiency with Facets, Cactus and Macess within 6 months from date of hire.
• Understanding of health insurance reimbursement models.
• Neat, well-groomed, professional appearance with positive, enthusiastic attitude.
• Able to demonstrate strong relationship building skills.
MVP Health Care is a nationally-recognized, regional not-for-profit health plan. We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company. Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!
625 State Street
Schenectady, NY 12305
Job Posting Entered On :
Job Posting Expires On :