Please Enable Cookies to Continue Please enable cookies in your browser to experience all the personalized features of this site, including the ability to apply for a job.Welcome pageReturning Candidate? Network Development Representative - Adams, Brown and Macoupin CountiesJob Location US-IL-QuincyJob ID 2017-4695Category Network DevelopmentBusiness Line MHP Illinois Overview Who we are:Meridian is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry. We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in five different states (Michigan, Illinois, Indiana, Kentucky, and Ohio). Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities. A Day in the Life of a Provider Network Development Representative:This position is to create an educated and comprehensive provider network in all Meridian Health Plan (MHP) assigned territories. The preferred candidate will reside within their assigned territory and have experience contracting with Hospitals, PHOs, large provider groups, and individual practitioners for Medicaid, Medicare and Commercial Networks. Responsibilities Prospecting to potential providers for inclusion in the MHP Provider NetworkCoordinating the entire contracting process for all potential providers, including prospecting, negotiation, credentialing and orientationCollecting all practitioner and ancillary signed contracts, applications and necessary credentialing information.Works in concert with other departments to ensure that exceptional quality standards are maintainedEducating providers on MHPs provider policies and proceduresIncreasing HEDIS scores in the assigned territorySpecial projects related to provider development and educationProvide exceptional customer service to our Provider NetworkProvider Network reporting for State expansion requirementsEducation of the Provider Portal to all contracted MHP ProvidersVisiting a minimum of 25 on-site office visits per week; including courtesy, HEDIS and cold-callsComplete change forms and top sheets when needed to update Provider changes and or additions in MCS (complete and submit appropriate documentation for proper set up in MCS) Qualifications What you can bring to Meridian:High school diploma is required.Pursuit of a Bachelors degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred.One year of provider services or managed care experience is preferred.Basic knowledge of MHPs philosophy, organizational structure and plan overviewBasic knowledge of MHPs practitioner, hospital and ancillary agreementsBasic knowledge of MHPs credentialing requirements for all providersBasic knowledge of managed care reimbursement methodsBasic knowledge of Medicaid managed care, including but not limited to, State of Illinois guidelines, reimbursement and competitorsKnowledge of MHPs provider manual, including policies and proceduresComputer skills, including working knowledge of Excel and Oracle softwareFollow up skills, with a do whatever it takes attitudeOrganizational skillsAbility to communicate clearly and concisely both orally and in writingAbility to work as part of a team while maintaining and exceeding individual goals and objectivesWhat Meridian can offer YOU:Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members. Opportunity to work with the industrys leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.Meridian offers 401k matching that is above the national average. Full-time MHP employees are eligible for tuition reimbursement towards Bachelors or Masters degrees.Meridians Chicago location is conveniently located in the Chicago Loop, and provides commuting benefits including discounts for public transportation and parking structures Regular activities such as sports leagues, mix n mingle events, and volunteer opportunities take place in neighborhoods throughout the cityMeridian is an Equal Opportunity EmployerOptionsApply for this job onlineApplyShareSorry the Share function is not working properly at this moment. Please refresh the page and try again later.Share on your newsfeed Connect With Us! Not ready to apply? for general consideration. Software Powered by iCIMS