Director, Provider Relations
Versant Health, bringing you Davis Vision and Superior Vision, is a leading provider of vision and eye health solutions. We offer a full spectrum of services in the vision care marketplace. Our mission is very real to our members: we help them enjoy the wonders of sight through healthy eyes and vision. What you do as a Versant Health Associate matters. 33 million Americans count on us to provide access to annual eye exams and corrective eyewear. We are here to change the face of vision care, and together we will make this happen.
We are dedicated to you– we provide a professional work environment, competitive benefits, equal opportunities and potential to grow with us. We guide you to what’s right for you- as leaders in the industry, we guide and coach Associates to give them opportunities to reach their full professional potential. We think ahead for you- you’ll enjoy a variety of benefits for those times when you need extra support.
Scope and Purpose of Position
The Director of Provider Relations is responsible for the management, retention and relationship of all aspects of the provider network. It is expected that they would think strategically to position the Versant Health Network in the best way to serve Versant Health, its clients and its members. They will engage professionally and strategically with clients, third parties, regulatory entities, industry personnel, vendors and others to meet certain objectives. The ideal candidate for this position will be committed to delivering the highest level of professional dedication, performance and competence. This position requires an individual who is a highly effective project and relationship manager with experience in the insurance/managed care industry. The Director of Provider Relations must be willing and capable of learning and advancing Versant Health’s marketing and brand methodology and customer-centric philosophy with a focus on building the ECP network and building a strong relationship with our ECPs. The Director of Provider Relations is responsible for provider contracting initiatives, provider problem-solving, including but not limited to claims, reimbursement, and contract issues.
- Monitors network to ensure financial, quality, and access standards are met.
- Responsible for measuring provider satisfaction and working with other internal company entities to ensure interactions and operations are in line with excellent provider satisfaction.
- Negotiate provider agreements as required to successfully meet the needs of Versant Health members enrolled in a variety of Versant Health products and services.
- Manages the overall network to ensure it meets access requirements, regulatory requirements and sales and client management requirements on behalf of our clients
- Interact with providers on an ongoing basis to maintain and develop positive and productive relationships. In this capacity, assures that our contractual commitments are met.
- Develop and provide appropriate network management and analysis reports to evaluate and focus on problem solving any issues resulting in minimal turnover of providers.
- Oversee the Development, Coordination and Implementation of provider educational materials, marketing materials and other ECP facing materials.
- Understands complex issues causing inefficiency in operation and seeks resolution.
- Plans, coordinates and implements periodic provider orientations as needed.
- Interacts with Sales staff, understanding the network needs as perceived by clients and brokers. Responds appropriately and timely.
- Researches network access of providers by specialty and geographic location. Recommends and implements plan to secure network needs.
- Takes lead role in company initiatives. Creates implementation plans and leads projects through completion.
- Provide network activity and other business related reports as requested.
- Understanding of unique provider contracting relationships and basic understanding of claims payment systems.
- Develop and maintain effective relationships with internal resources to ensure customer-centric delivery of all related service to providers, clients, members, and brokers.
- 25% travel may be required.
- Other duties as assigned.
Education & Experience
- Bachelor’s Degree required.
- Minimum 8 years of relevant experience preferably in a managed care environment with a focus on provider relations and contracting
- Vision care provider network development preferred
- A proven record track record with medical, vision care, dental, HMO, or PPO products
- Understanding of NCQA and QA initiatives related to provider contracting
- Exceptional verbal and written communication skills to effectively interact with providers, members, clients and co-workers
- Highly effective presentation skills with ability to deliver presentations to all levels in a provider’s organization
- Strong persuasive, and negotiations skills to influence contracting decisions
- High degree of initiative and persistence
- Strong analytical and problem-solving skills with demonstrated ability to utilize good judgment
- Strong execution and follow-up skills
- Excellent organizational and planning skills with ability to coordinate multiple tasks and projects
- Well organized and resourceful
- Proficiency with Windows software, Excel, Microsoft Word, Access, and Power Point