Provider Relationship Account Conultant

The Provider Relationship Account Consultant role is based in the field, enabling travel to client sites or designated locations as needed. The ideal candidate will visit providers in the North West region of Iowa up to 15 times per quarter.

About the role

This position supports providers in the North West region of Iowa and is responsible for maintaining positive relationships with the provider community. Key responsibilities include:

• Developing and maintaining positive provider relationships via email, telephonic, and face-to-face outreach
• Communicating administrative and programmatic changes, facilitating provider education, and resolving provider issues
• Triaging issues and submitting work requests with internal matrix partners
• Coordinating communication on administrative and medical policy, reimbursement, and provider utilization patterns
• Conducting outreach to support understanding of managed care policies and procedures, and on various initiatives and programs
• Assisting with provider training, including developing and distributing materials
• Assisting with Annual Provider Satisfaction Surveys, implementing corrective action plans, and monitoring education and non-routine claim issues
• Identifying and reporting on provider utilization patterns impacting quality-of-service delivery
• Researching issues impacting future provider contract negotiations or network retention
• Traveling to worksites and other locations as necessary

Responsibilities

Develops and maintains positive provider relationships with the provider community via a mixture of email, telephonic, and face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.

Collaborates with internal matrix partners to triage issues and submit work requests.

Generally assigned to a portfolio of providers within a defined cohort.

Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.

Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.

Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs.

Coordinates and conducts provider training including developing and distributing provider relations materials.

May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.

May coordinate Provider Manual updates/maintenance.

Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.

Researches issues that may impact future provider contract negotiations or jeopardize network retention.

Travels to worksite and other locations as necessary.

Requirements

Requires a bachelor’s degree; a minimum of 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.

Preferred skills, capabilities, and experiences include claims experience, Medicaid/Medicare experience, and managed care organization experience.

Qualifications

Minimum requirements include a bachelor’s degree and a minimum of 2 years of customer service experience, including 1 year in a healthcare or provider environment.

Skills

Claims experience preferred.

Medicaid/Medicare experience preferred.

Manged care organization experience preferred.

Benefits

Includes a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Pay

N/A

Schedule

N/A

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.