PPO Developer

Job Description

Job Description

Responsible for increasing in-network claims penetration and network revenue through

effective contracting and management of contracted providers within CorVel’s proprietary networks. Frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity.

This individual must combine strong interpersonal and negotiation skills with resourcefulness and aptitude in the medical provider market.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES :

• Implement medical providers through use of correspondence and telephonic contact
• Verify all provider signatures, contracts and documentation after submitting for internal processing
• Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers
• Distribute and maintain provider manual and orientation materials per state guidelines
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures
• Provide assistance and be responsive to staff requests for assistance, information regarding the network, both locally and nationally
• Oversee distribution of executed contracts and maintenance of database
• Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB
• Coordinate and process provider roster updates at least annually or as otherwise required
• Perform facility site surveys as needed per credentialing requirements or state guidelines
• Identify anemic specialties within network and generate a recruitment list
• Identify, initiate, follow-up, negotiate, and finalize effective contracts and renegotiation efforts with providers
• Work jointly with District Manager (or above) and management team to set targets based on client needs and strategic direction for your market, utilizing and accurately interpreting all appropriate analytical data (to include Ceris analytics) in determining the validity of provider participation / nomination
• Build relationships and interact with providers and share CorVel’s value and differentiators through community involvement, onsite meetings, mailings and other marketing efforts
• Become a state expert of local compensation rules and regulations relating to the ability to channel patients, reimbursement schedules, PPO reduction limitations, etc.
• Interface with National Database (NDB) Team to add new contracts to the CorVel database
• Responsible to ensure accuracy and timeliness for updated provider information
• Screen incoming provider applications and agreements for completeness and, when appropriate follow-up with letters and / or telephone calls to obtain incomplete or missing information
• Research network problems and initiate resolution; promote strong customer service
• Interact with CorVel clients in providing panel development, stewardship meetings, etc.
• Other duties as assigned
• Requires regular and consistent attendance
• Maintain a professional appearance

KNOWLEDGE & SKILLS :

• Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative
• Proven track record of delivering concrete results in negotiations
• Excellent written communication skills
• Superb attention to detail and ability to deliver results in a fast paced and dynamic environment.

EDUCATION / EXPERIENCE :

• Undergraduate Bachelor of Arts or Sciences degree, liberal arts or business
• Demonstrated success in provider recruitment
• Two years of sales and / or negotiating experience
• Proficient in Microsoft applications and presentation software

PAY RANGE :

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors : federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.

Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.

The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range : $58,282 $93,870

A list of our benefit offerings can be found on our CorVel website : CorVel Careers Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About CorVel

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.

CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients.

We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w / Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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