Network Service Consultant

Peak Health

Network Service Consultant developing provider relationships and educating stakeholders for Peak Health’s health insurance plans. Supporting credentialing, contracting, regulatory reporting, and network strategy.

Posted 8/14/2026full-timeRemote • Virginia, West Virginia • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider relations, including credentialing, contracting, and regulatory compliance, while effectively communicating and educating stakeholders. Proficient in managing provider networks and understanding performance-based reimbursement programs.

Highest-signal resume keywords

Provider CredentialingRegulatory ReportingValue Based ReimbursementProvider Quality Measurement SystemsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Provider ContractingClaims ManagementData ManagementPerformance-Based Reimbursement ProgramsHealth EducationPopulation HealthPharmacy ManagementElectronic Health RecordsHealth Information ExchangeProvider Quality Measurement

Soft Skills

Relationship BuildingStrategic ThinkingAttention to DetailExcellent Communication

Industry Keywords

Commercial ProductsMedicare AdvantageMedicaidPEIA ProductsCMS RegulationsWV Department of InsuranceHEDISMedicare STARSPCMH Quality ProgramsWest Virginia Provider Relationships

About the role

Key responsibilities & impact

Develop and maintain collaborative relationships with providers, including physicians, hospitals, ancillary providers, and vendors
Shape the provider network landscape through objective data and education across stakeholders and product lines
Educate providers on credentialing, contracting, authorizations, referrals, claims and encounters, grievances and appeals, health education, population health, care management, pharmacy management, electronic health records, health information exchange, data exchange, and regulatory updates
Conduct provider outreach through email, telephone, in-person meetings, and webinars
Assess provider efficiencies when interacting with the health plan
Conduct initial provider orientations and ongoing educational outreach
Conduct group training sessions
Assist with provider contract questions, research problems, and resolve escalated issues
Represent the health plan at healthcare association functions
Participate in regulatory reporting for provider networks
Monitor competitors and market regulations
Support strategic positioning to develop and maintain provider networks
Assist the Credentialing Department with difficult-to-obtain documents
Collaborate with Claims Operations, Medical Management, Credentialing, Contracting, Legal, Analytics, Compliance, Sales and Marketing, and Member and Provider Service teams
Report to the Manager Network Services as a member of the Provider Relations team

Requirements

What you’ll need

Bachelor’s Degree in business or a healthcare-related field
Basic understanding of contracts, Value Based Reimbursement, performance-based provider reimbursement programs, and Commercial, Medicare Advantage, Medicaid, and PEIA products
Understanding of regulatory reporting for provider networks, including the WV Department of Insurance, Department of Medicaid/Health Services, and CMS
Understanding of provider quality measurement systems such as Medicare STARS, HEDIS, and PCMH quality programs
Strategic thinking and attention to detail
Knowledge of federal and state laws, including CMS and BMS
Excellent written and oral communication
Demonstrated ability to build and retain relationships
Proficiency with Microsoft Office
Experience with Commercial, Medicare, and Medicaid products
Understanding of provider credentialing and data management processes
Working knowledge of claims and/or coding
Established provider relationships in West Virginia
Standard office-environment work conditions
Ability to travel to offsite meetings when required

Benefits

Comp & perks

Full-time employment
40 scheduled hours per week
Some travel may be required to offsite meetings
Reasonable accommodations may be made for individuals with disabilities