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 Network
- Coordinating the entire contracting process for all potential providers, including prospecting, negotiation, credentialing and orientation
- Collecting all practitioner and ancillary signed contracts, applications and necessary credentialing information.
- Works in concert with other departments to ensure that exceptional quality standards are maintained
- Educating providers on MHP’s provider policies and procedures
- Increasing HEDIS scores in the assigned territory
- Special projects related to provider development and education
- Provide exceptional customer service to our Provider Network
- Provider Network reporting for State expansion requirements
- Education of the Provider Portal to all contracted MHP Providers
- Visiting a minimum of 25 on-site office visits per week; including courtesy, HEDIS and cold-calls
- Complete 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)
What you can bring to Meridian:
- High school diploma is required.
- Pursuit of a Bachelor’s 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 MHP’s philosophy, organizational structure and plan overview
Basic knowledge of MHP’s practitioner, hospital and ancillary agreements
Basic knowledge of MHP’s credentialing requirements for all providers
Basic knowledge of managed care reimbursement methods
Basic knowledge of Medicaid managed care, including but not limited to, State of Illinois guidelines, reimbursement and competitors
Knowledge of MHP’s provider manual, including policies and procedures
Computer skills, including working knowledge of Excel and Oracle software
Follow up skills, with a “do whatever it takes” attitude
Ability to communicate clearly and concisely both orally and in writing
- Ability to work as part of a team while maintaining and exceeding individual goals and objectives
What 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 industry’s 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 Bachelor’s or Master’s degrees.
- Meridian’s 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 city
- Meridian is an Equal Opportunity Employer