Network Service Consultant

WVU Medicine

Network Service Consultant developing West Virginia provider networks for Peak Health, a health-plan organization. Educating providers, supporting regulatory reporting, and resolving network and contract issues.

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in provider network management, including credentialing, contracting, and regulatory compliance. Strong communication and relationship-building skills are essential for effective collaboration with healthcare stakeholders.

Highest-signal resume keywords

Provider Network ManagementRegulatory ReportingValue Based Reimbursement (VBR)Provider CredentialingMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Contract UnderstandingPerformance-Based Provider ReimbursementProvider Quality Measurement SystemsClaims KnowledgeData Management Processes

Soft Skills

Strategic ThinkingAttention to DetailRelationship BuildingExcellent Communication

Industry Keywords

Commercial ProductsMedicare AdvantageMedicaidPEIA ProductsCMS RegulationsHEDISMedicare STARSPCMH Quality ProgramsWV Department of InsuranceDepartment of Medicaid/Health Services

About the role

Key responsibilities & impact

Develop and maintain collaborative relationships with physicians, hospitals, ancillary providers, and vendors
Shape the provider network landscape through objective data and education across stakeholders, markets, and product lines
Educate providers on credentialing, contracting, authorizations, referrals, claims, 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 dealing 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

Requirements

What you’ll need

Bachelor’s Degree in business or a healthcare-related field
Basic understanding of contracts, Value Based Reimbursement (VBR), 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
Willingness to travel to offsite meetings when required

Benefits

Comp & perks

Full-time, 40 scheduled weekly hours
Remote work location
Some travel may be required to offsite meetings